Cholesterol and Coronary Heart Disease: A Perspective

In this issue ofTHE JOURNALis the statement of the National Institutes of Health Consensus Development Conference on lowering blood cholesterol¹; their recommendations are reasonable and can be supported. However, it is important at this point to review certain related issues. There is no doubt that elevated blood cholesterol levels and other "high-risk" factors, such as cigarette smoking, high blood pressure, obesity, physical inactivity, male sex, stressful lifestyle, and strong family history, are associated with an increased risk of development of coronary artery disease. However, even if all the recognized risk factors were eliminated except for the male sex, coronary atherosclerosis and death from coronary artery disease willnotdisappear. Therefore, it needs to be recognized that we donotyet know the cause(s) of coronary atherosclerosis²and there is a need for continued research to discover the cause(s) and specific treatment of coronary atherosclerosis. The recent interest,