Biology of cholesterol, lipoproteins and atherosclerosis.

This brief review summarizes the evidence linking cholesterol and lipoproteins in blood plasma to the pathogenesis of atherosclerotic disease. The role of specific lipoprotein classes and of modified lipoproteins in the early stages of atherogenesis is emphasized. Clinical trials have provided persuasive evidence of the effectiveness of cholesterol-lowering in modifying the course of coronary heart disease and the progression of atherosclerotic plaques. No conclusions are yet possible, however, about the effect of changes produced in these trials on the concentration of lipoproteins other than low density lipoproteins. Attention is drawn to implications of recent guidelines for cholesterol-lowering for the design of trials of lipid-lowering in hypertensive patients, and to some recent evidence for genetic linkage between hypertension and hyperlipidemia in the pathogenesis of coronary heart disease.