By the early 1970s, Albrink’s interpretation of the evidence had been confirmed independently, first by Peter Kuo of the University of Pennsylvania, then by Lars Carlson of the Karolinska Institute in Stockholm, and by the future Nobel laureate Joseph Goldstein and his colleagues from the University of Washington. All three reported that high triglycerides were considerably more common in heart-disease victims than was high cholesterol. In 1967, Kuo reported in The Journal of the American Medical Association that he had studied 286 atherosclerosis patients, of whom 246 had been referred to him by physicians who thought their patients had the genetic form of high cholesterol. This turned out to be the case for fewer than 10 percent. The other 90 percent had carbohydrate-induced lipemia, and, for most of these patients, their sensitivity to carbohydrates had elevated both their triglyceride levels and their cholesterol. When Kuo put his patients on a sugar-free diet, he reported, with only five to six hundred calories of starches a day, both their triglyceride levels and their cholesterol lowered. Two months later, JAMA published an editorial in response to Kuo’s article, suggesting that the “almost embarrassingly high number of researchers [who had] boarded the ‘cholesterol bandwagon’” had done a disservice to the field. “This fervent embrace of cholesterol to the exclusion of other biochemical alterations resulted in a narrow scope of study,” the editorial said. “Fortunately, other fruitful approaches have been made possible in the past few years by identification of the fundamental role of such factors as triglycerides and carbohydrate metabolism in atherogenesis.”

By then, however, the science had already become secondary to more practical issues. Despite JAMA’s optimism that a new era was dawning, it was no longer a question of whether it was cholesterol or triglycerides that caused atherosclerosis and heart disease, whether saturated fat or carbohydrates were to blame, but which of the two hypotheses dominated the research. Here Keys’s hypothesis had precedence. A generation of clinical investigators—the “cholesterol bandwagon”—had gathered an enormous amount of data, however ambiguous, on cholesterol levels and heart disease; only Albrink, Kuo, and a handful of other researchers had studied triglycerides. Only Gofman had studied the VLDL particles that transport triglycerides through the circulation.