Cholesterol, Atherosclerosis, Lipid-Lowering Therapy. Is It Completely Clear?

Introduction . Many issues related to the pathogenesis and treatment of atherosclerosis remain incompletely studied. Results of lipid-lowering therapy (LLT) for cardiovascular diseases (CVD) do not fit into the atherosclerosis cholesterol concept, which dictates the need to analyze existing views. The aim was to demonstrate the contradictory role of cholesterol in atherosclerosis and related CVD, evaluate the efficacy of LLT and identify promising directions of atherosclerosis treatment. Materials and methods . Publications found in PubMed, Index Medicus, ResearchGate, Google Scholar, eLibrary were analyzed. The depth of the search was timeless. Search words: atherosclerosis, lipoproteins, cholesterol, inflammation, lipid-lowering therapy. Criteria for selection of publications: results of studies and systematic reviews on the topic under consideration. Results and discussion . The analysis of literature data demonstrated the absence of clear relationship between the concentration of serum cholesterol and the incidence of CVD. Atherogenic properties of hypercholesterolemia may be mediated by concomitant causes. The revealed discrepancy between reduction in the frequency of adverse vascular events and LLT effect indicates the complex multifactorial pathogenesis of atherosclerosis, in which cholesterol metabolism occupies only part of this process. The role of systemic and local vascular inflammation, modified forms of lipoproteins is of great importance in the atherosclerosis progression. The prospect of studying the intestinal microbiota is emphasized. Conclusion . Disturbance of lipid metabolism is important, but not the only link in the pathogenetic chain. From these positions, the improvement of LLT methods only seems unpromising. The development of other approachesis required, taking into account the multifactorial nature of atherogenesis.