ABSTRACT
Among all of the risk factors which have been linked to coronary artery disease (CAD), hypercholesterolaemia appears to be pre-eminent. Populations whose plasma cholesterol levels are inherently low can withstand exposure to high levels of tobacco consumption and arterial hypertension without developing significant coronary disease. Conversely, in Western industrialized countries, where hypercholesterolaemia is endemic, coincidence of the other two risk factors is linked to more extensive aortic atherosclerosis1,2 and to a multiplicative increase in coronary morbidity and mortality. The lipid hypothesis, formulated more than 20 years ago, proposed that the reduction of plasma-or more specifically low-density lipoprotein (LDL)—cholesterol would lead to a fall in coronary disease. This chapter assesses the current status of that hypothesis in the light of recent clinical trial evidence derived from the use of statins in clinical practice.
