The pathogenesis of
arteriosclerosis is not yet fully understood. The growing body of scientific information strongly indicates that the plasma
lipoproteins are playing a crucial role in the development of this disease. We now have conclusive information that
dietary cholesterol can produce
arteriosclerosis in animals and its removal from the diet can result in regression of these lesions. Most importantly, we know that reducing plasma
cholesterol in humans will prevent mortality and morbidity related to the clinical sequelae of
arteriosclerosis. A diet can be prescribed that can produce profound reductions in
lipoprotein levels in many individuals. The rate of success in achieving modifications that reduce plasma
cholesterol is very high. Most patients over time find a diet with reduced
cholesterol and saturated fat to be quite palatable. As food suppliers become more active in emphasizing low fat, low
cholesterol products, and as restaurants see a demand for healthier entrees, the task for the physician and nutritionist will become much easier. Achieving sustained
weight reduction is a much more difficult problem, but this too can be accomplished in many patients if the health professionals maintain a hopeful supportive approach. Ultimately, it is the patient's responsibility to bring about these lifestyle changes. It is the physician's and nutritionist's job to monitor the process and provide sound information and encouragement. For individuals with severe
lipoprotein disorders such as
familial hypercholesterolemia where
diet therapy is helpful but not adequate, the use of medications is now indicated (
bile acid binding resins and
nicotinic acid). Other medications that promise additional effectiveness and safety are under development (
Compactin,
Mevinolin). It is our belief that control of
coronary heart disease and
stroke requires appropriate treatment of
lipoprotein disorders and the methods for a strong beginning in this endeavor are at hand.