Reducing serum total cholesterol alone is insufficient to lower coronary heart disease risk; other factors, including diet, are crucial.

“it appears that reductions in serum total cholesterol levels are not likely to bring cultures with a high coronary heart disease risks such as the United States and Northern Europe back to a CHD mortality level characteristic for the Mediterranean Japanese cultures unless other factors are also changed Mediterranean and Japanese diets low in saturated fat and rich in antioxidants may have beneficial effects both on the oxidizability of LDL particles and on thrombogenesis which also seems to depend on omega-6 fats just as an aside apart from an effect on LDL levels per se this stresses the importance of factors other than serum cholesterol blood pressure and smoking status such as diet and CHD prevention”