ABSTRACT
Melissa Ferraro-Borgida University of Connecticut School of Medicine, Farmington, and Hartford Hospital, Hartford, Connecticut
David Waters San Francisco General Hospital, San Francisco, California
I. INTRODUCTION
The relationship between serum cholesterol levels and the risk of cardiovascular disease has now been understood for many years. Despite this, the formulation of guidelines to diagnose and treat cholesterol levels is extremely complicated and has engendered considerable controversy. Reasons for this include the substantial overlap in serum cholesterol levels between subjects with and without atherosclerosis and the epidemiological observations that the risk gradient appears to extend across a very wide range of cholesterol levels. Among the 361,662 men screened in the Multiple Risk Factor Intervention Trial (MRFIT), the risk of coronary heart disease death decreased in a curvilinear fashion from 300 to 140 mg/dL (1). Among middle-aged factory workers in Shanghai, where only 7% of deaths were attributed to coronary heart disease (CHD) and where the mean serum cholesterol level was only 162 mg/dL, cholesterol levels and coronary mortality still strongly correlated (2).
