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Cholesterol Lowering

  • Terje R. Pedersen
Part of the Contemporary Cardiology book series (CONCARD)

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.

Keywords

Coronary Heart Disease Acute Coronary Syndrome Coronary Atherosclerosis Coronary Heart Disease Event Coronary Heart Disease Patient 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Copyright information

© Springer Science+Business Media New York 1999

Authors and Affiliations

  • Terje R. Pedersen

There are no affiliations available

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