Symposium on Significance of Lowered Cholesterol Levels

To the pathologist, the significance that lowered levels of serum cholesterol might have in the prevention or amelioration of atherosclerosis in man hinges on the question, "How fundamental is the role of this substance in atherogenesis?" Cholesterol, in both free and esterified forms, is present in higher quantities in atheromatous arteries than in normal ones. This fact, recognized by pathologists for more than a century, has been verified repeatedly by direct biochemical estimations of lipids in the tissue. Pertinent data of this type have been obtained from coronary arteries of patients dying of myocardial infarction in which four times as much cholesterol was found as in those of patients dying of other causes.1The cholesterol, phospholipid, and neutral fat ratios in arterial walls, however, are the same as those of blood plasma,2raising the question, "Why should cholesterol in the serum be given more pathogenic emphasis in atheroma