Cholesterol and Coronary Heart Disease

SEVERAL important developments have recently given new impetus to prevention of coronary heart disease (CHD) through control of the plasma cholesterol level. Three advances have been particularly dramatic. First, the Nobel prize in medicine was awarded in 1985 to Drs Joseph Goldstein and Michael Brown for their discovery of cell-surface receptors for low-density lipoproteins (LDLs); their finding was fundamental to our understanding of how plasma cholesterol levels are controlled. Second, the Lipid Research Clinics (LRC) Coronary Primary Prevention Trial (CPPT)1reported that lowering of the plasma cholesterol level by bile acid sequestrants reduces the frequency of several manifestations of CHD, including myocardial infarction. And third, a new class of cholesterollowering drugs, namely, competitive inhibitors of 3-hydroxy-3-methylglutaryl coenzyme A reductase, the rate-limiting enzyme in cholesterol synthesis, has been shown to markedly lower cholesterol levels.2-4Although these inhibitors are not yet approved for clinical use, they reveal the potential for