Is cholesterol the major lipoprotein risk factor in coronary heart disease? A Franco-Scottish overview

There has been much debate over the past three decades concerning the role of hyperlipidaemia in coronary heart disease (CHD) and the efficacy of reducing plasma lipids levels. Although reduction in plasma cholesterol has been associated with a favourable effect on both primary and secondary CHD, there is a growing feeling that cholesterol may not be the only significant lipoprotein risk factor to be involved. Only relatively recently has the true role of triglycerides become apparent. Studies have indicated that the greatest reduction in CHD with some treatments has been found in those patients in whom high triglyceride levels accompany hypercholesterolaemia. In particular, in younger patients who have suffered a myocardial infarction, hypertriglyceridaemia is more common than hypercholesterolaemia. Nevertheless, recent large studies have shown that reduction of low-density lipoprotein (LDL) is beneficial, even in post-infarction patients with a relatively normal total cholesterol level. Furthermore, studies with fibrates and with HMG Go-A reductase inhibitors have indicated that progression of atheromatous lesions can be halted and in may cases there is evidence of regression. Continuing research on the pathophysiology of atherosclerosis, including the role of macrophages and thrombotic involvement, will further define the role of hypolipidaemics in the prevention and management of coronary heart disease.