ABSTRACT
Atheroma was recognized in ancient Egypt, but only recently has its impact on population mortality been fully appreciated. In industrialized countries, coronary atherosclerosis and its clinical manifestation, ischemic heart disease, is responsible for the majority of deaths among all adults age 40 years and over. Although the lesion is multifactorial in origin, its frequent enrichment in cholesterol has led to the growing conviction that it results from a steady and progressive lifetime uptake of plasma cholesterol into the arterial subintimal space. This concept, which accords with epidemiological evidence associating raised circulating cholesterol levels with increased risk of coronary mortality, has led to the evolution of the cholesterol hypothesis that since hypercholesterolemia is associated with coronary heart disease (CHD), cholesterol-lowering strategies should be instrumental in its avoidance. The West of Scotland Coronary Prevention Study (WOSCOPS) examined that hypothesis (1).
