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Twenty-five rural South African black males who worked on an egg farm an average of 4.1 yr had a mean habitual cholesterol intake of 1240 mg/d with fat supplying only 20% of total energy. Although total serum cholesterol was slightly although significantly higher and serum triglycerides significantly lower than those for a control group, no disturbance was evoked in the distribution of cholesterol between HDL, LDL, and VLDL fractions. Coagulation factors were within the normal range, but the high egg consumer group had significantly higher plasma fibrinogen and factor IX levels with a shorter mean prothrombin and partial thromboplastin time, possibly indicative of a slight hypercoagulable state. Apparently rural blacks can handle a very high cholesterol intake without meaningful disturbance in serum lipid homeostasis. [ABSTRACT FROM AUTHOR]

There has been much controversy concerning the value of efforts to reduce blood cholesterol levels. In this contribution, the risks and benefits of interventions are discussed. Lowering cholesterol level by drugs is not recommended except in a small minority of subjects at very high risk of coronary heart disease (CHD), since it causes an excess of non-CHD deaths. Dietary intervention, by contrast, is safe. However, for it to be effective it must be sufficiently vigorous to achieve a drop in blood cholesterol of at least 6%, though considerably more is preferable. This action should be part of a more general effort aimed at the prevention of all Western diseases based on changes in lifestyle. [ABSTRACT FROM AUTHOR]

The article focuses on the condition of public health in various countries. In the United States there is now 99% survival of infants, with life expectancy of 70-00 years and more, a far cry from the figure of 50 years in 1900. Funds for health have reached a high of 16% in the United States. The chief "killers", coronary heart disease (CHD) and stroke, have had their mortality rates almost halved, yet CHD incidence rate has not changed. Total mortality rate from cancer is stationary, or falling only slightly. The prevalence of obesity in women, and of hypertension and diabetes, already exceeds that in the white population. In most countries there is a tremendous health burden from infections, not only from malaria, but also from tuberculosis, and, more recently, from HIV infection. Rates of HIV infection in South Africa are the highest in the world; in parts, nearly 50% of antenatal African women are infected. In Spain, although mean serum cholesterol is rising, CHD mortality is falling. In Japan, although some risk factors are rising, inexplicably, mortality rates for breast and colon cancers are falling.