Changes in total cholesterol levels in Western societies are not related to statin, but rather dietary factors: the example of the Icelandic population.

Introduction In a recent report by Farzadfar et al. on global trends in serum total cholesterol (TC), it is suggested that HMG-CoA reductase inhibitors (statins) are important for lowering of average TC in high-income countries and that statin use is a likely driver of the polarized trend in average TC seen between lowand high-income countries. On the other hand, our results show that statins are not a key driver of lowering of average TC in the Icelandic population observed over the last decades. This is further supported by findings from USA, Scandinavia, and Czech Republic. Where the drop in cardiovascular mortality has been examined, by applying the IMPACT model, that examines the contribution of changes in various risk factors and interventions on cardiovascular mortality, the role of reduction in cholesterol levels has been demonstrated and largely shown to be related to other factors than intervention. 9 The tendency to overestimate the impact of effective pharmacological intervention on the population cholesterol level calls for an understanding of which factors have led to the change in population TC. This applies to society at large, but especially to policy makers who need to allocate limited resources in health care and disease prevention in the most efficient way. Physicians have an important role to play to share their knowledge in this context. This is particularly important in the developing countries where cardiovascular diseases are on an increase.