Clinical Associations of Hypocholesterolaemia
There is cogent evidence to justify the treatment of hypercholesterolaemia in individuals with elevated levels of low density lipoprotein (LDL), and to reduce the mean plasma cholesterol of populations at high risk of coronary disease (1,2). However cholesterol and its precursor hydroxymethylglutaryl CoA are important metabolic intermediates, and unesterified cholesterol is an obligatory component of the plasma membranes of all cells. As circulating LDL is a major source of the cholesterol of extrahepatic cells, it may be hypothesized that very low plasma levels of this lipoprotein may have untoward effects. The hypothesis merits critical examination, for it has bearing on recommendations to the population to restrict intake of saturated fatty acids and cholesterol, and on the use of lipid- lowering drugs in clinical practice.
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