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Cholesterol Lowering

  • Chapter
Management of Acute Coronary Syndromes

Part of the book series: Contemporary Cardiology ((CONCARD))

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Abstract

The evidence that cholesterol has the central role in the atherosclerotic process is derived from all disciplines of medical research, ranging from molecular biology to randomized clinical trials. The epidemiologic proof is particularly strong and consistent. Coronary heart disease (CHD) is rare in populations with low serum cholesterol levels (1,2). In comparisons of countries with varying incidence of CHD, there is a strong positive correlation between serum cholesterol levels and the risk of coronary heart disease events (3). In countries experiencing an increase in mortality from CHD, a preceding substantial rise in serum cholesterol levels was observed (4). In Finland, where the mortality from CHD has been the highest in the world, the recent decline in mortality has been preceded by a decline in population serum cholesterol levels (5). In epidemiologic studies within Western societies serum cholesterol is a strong risk factor for CHD (6,7). A raised level of low-density lipoprotein (LDL) constitutes the main cause of coronary atherosclerosis (8), in particular small, dense LDL (9). In addition, there is strong evidence that low levels of serum high-density lipoprotein (HDL) cholesterol and high levels of serum triglycerides are independent risk factors of CHD (7,10,11). The combination of borderline high-risk LDL cholesterol, raised triglycerides, small LDL particles, and low HDL cholesterol has been labeled as atherogenic lipoprotein phenotype (12) or atherogenic dyslipidemia (13), being a typical feature of the metabolic syndrome. The other components of this syndrome are central obesity, hypertension, insulin resistance, and a procoagulant state. Increasing evidence is identifying another apolipoprotein B-containing particle, intermediate-density lipoprotein (IDL), as atherogenic (14–17). The predictive information of serum triglyceride levels may reflect high levels of very-low-density lipoprotein (VLDL) and IDL as triglyceride-rich lipoprotein particles.

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Authors
  1. Terje R. Pedersen MD, PhD
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  1. Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA

    Christopher P. Cannon MD

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Pedersen, T.R. (1999). Cholesterol Lowering. In: Cannon, C.P. (eds) Management of Acute Coronary Syndromes. Contemporary Cardiology. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-59259-731-4_23

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  • DOI: https://doi.org/10.1007/978-1-59259-731-4_23

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