This Article  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in JAMA  Social Bookmarking   What's this?

JAMA. 1985;253(14):2080-2086.

Abstract
Coronary heart disease is responsible for more than 550,000 deaths in the United States each year. It is responsible for more deaths than all forms of cancer combined. There are more than 5.4 million Americans with symptomatic coronary heart disease and a large number of others with undiagnosed coronary disease, many of them young and highly productive. It has been estimated that coronary heart disease costs the United States more than $60 billion a year in direct and indirect costs.

Coronary heart disease is caused by atherosclerosis, a slowly progressive disease of the large arteries that begins early in life but rarely produces symptoms until middle age. Often the disease goes undetected until the time of the first heart attack, and this first heart attack is often fatal. Modern methods of treatment have improved greatly the outlook for patients having heart attacks, but major progress in our battle against this number 1 killer must rest on finding preventive measures.

A number of risk factors have been identified as strongly associated with coronary heart disease. Cigarette smoking, high blood pressure, and high blood cholesterol levels are the most clearly established of these factors. Risk is greater in men, increases with age, and has a strong genetic component. Obesity, diabetes mellitus, physical inactivity, and behavior pattern are also risk factors.

A large body of evidence of many kinds links elevated blood cholesterol levels to coronary heart disease. However, some doubt remains about the strength of the evidence for a cause-and-effect relationship. Questions remain regarding the exact relationship between blood cholesterol and heart attacks and the steps that should be taken to diagnose and treat elevated blood cholesterol levels.

To resolve some of these questions, the National Heart, Lung, and Blood Institute (NHLBI) and the National Institutes of Health Office of Medical Applications of Research convened a Consensus Development Conference on Lowering Blood Cholesterol to Prevent Heart Disease from Dec 10 to 12, 1984. After hearing a series of expert presentations and reviewing all of the available data, a consensus panel of lipoprotein experts, cardiologists, primary care physicians, epidemiologists, biomedical scientists, biostatisticians, experts in preventive medicine, and lay representatives considered the evidence and agreed on answers to the following questions:

1. Is the relationship between blood cholesterol levels and coronary heart disease causal?
   
2. Will reduction of blood cholesterol levels help prevent coronary heart disease?
   
3. Under what circumstances and at what level of blood cholesterol should dietary or drug treatment be started?
   
4. Should an attempt be made to reduce the blood cholesterol levels of the general population?
   
5. What research directions should be pursued regarding the relationship between blood cholesterol and coronary heart disease?
   

Footnotes
From the Office of Medical Applications of Research, National Institutes of Health, Bethesda, Md.

Reprint requests to Office of Medical Applications of Research, Bldg 1, Room 216, National Institutes of Health, Bethesda, MD 20205 (Michael J. Bernstein).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Effect of Massive Weight Loss on Inflammatory Adipocytokines and the Innate Immune System in Morbidly Obese Women
Manco et al.
J. Clin. Endocrinol. Metab. 2007;92:483-490.
ABSTRACT | FULL TEXT  

Predictors of weight loss and reversal of comorbidities in malabsorptive bariatric surgery
Valera-Mora et al.
Am. J. Clin. Nutr. 2005;81:1292-1297.
ABSTRACT | FULL TEXT  

Thematic review series: The Pathogenesis of Atherosclerosis. An interpretive history of the cholesterol controversy: part II: the early evidence linking hypercholesterolemia to coronary disease in humans
Steinberg
J. Lipid Res. 2005;46:179-190.
ABSTRACT | FULL TEXT  

The Canadian Experience: Why Canada Decided Against an Upper Limit for Cholesterol
McDonald
J. Am. Coll. Nutr. 2004;23:616S-620S.
ABSTRACT | FULL TEXT  

Task Force #3--getting results: who, where, and how?
Ades et al.
J Am Coll Cardiol 2002;40:615-630.
FULL TEXT  

Higher Usual Dietary Intake of Phytoestrogens Is Associated With Lower Aortic Stiffness in Postmenopausal Women
van der Schouw et al.
Arterioscler. Thromb. Vasc. Bio. 2002;22:1316-1322.
ABSTRACT | FULL TEXT  

Disparities in the Diagnosis and Pharmacologic Treatment of High Serum Cholesterol by Race and Ethnicity: Data From the Third National Health and Nutrition Examination Survey
Nelson et al.
Arch Intern Med 2002;162:929-935.
ABSTRACT | FULL TEXT  

Dietary glycemic load assessed by food-frequency questionnaire in relation to plasma high-density-lipoprotein cholesterol and fasting plasma triacylglycerols in postmenopausal women
Liu et al.
Am. J. Clin. Nutr. 2001;73:560-566.
ABSTRACT | FULL TEXT  

Use of Simvastatin Treatment in Patients With Combined Hyperlipidemia in Clinical Practice
Vicari et al.
Arch Fam Med 2000;9:898-905.
ABSTRACT | FULL TEXT  

Effects of Protease Inhibitors on Hyperglycemia, Hyperlipidemia, and Lipodystrophy: A 5-Year Cohort Study
Tsiodras et al.
Arch Intern Med 2000;160:2050-2056.
ABSTRACT | FULL TEXT  

Food and nutrient exposures: what to consider when evaluating epidemiologic evidence
Sempos et al.
Am. J. Clin. Nutr. 1999;69 :1330S-1338S.
ABSTRACT | FULL TEXT  

Intracranial Arteries of Human Fetuses Are More Resistant to Hypercholesterolemia-Induced Fatty Streak Formation Than Extracranial Arteries
Napoli et al.
Circulation 1999;99:2003-2010.
ABSTRACT | FULL TEXT  

Cholesteryl Ester Hydroperoxide Lability Is a Key Feature of the Oxidative Susceptibility of Small, Dense LDL
Chancharme et al.
Arterioscler. Thromb. Vasc. Bio. 1999;19:810-820.
ABSTRACT | FULL TEXT  

The National Cholesterol Education Program: Progress and Prospects
Cleeman and Lenfant
JAMA 1998;280:2099-2104.
ABSTRACT | FULL TEXT  

Utility of Direct Measurement of Low-Density Lipoprotein Cholesterol in Dyslipidemic Pediatric Patients
Ticho et al.
Arch Pediatr Adolesc Med 1998;152:787-791.
ABSTRACT | FULL TEXT  

Effects of Diet and Exercise in Men and Postmenopausal Women with Low Levels of HDL Cholesterol and High Levels of LDL Cholesterol
Stefanick et al.
NEJM 1998;339:12-20.
ABSTRACT | FULL TEXT  

Two Major Loci Control Variation in ß-Lipoprotein Cholesterol and Response to Dietary Fat and Cholesterol in Baboons
Rainwater et al.
Arterioscler. Thromb. Vasc. Bio. 1998;18:1061-1068.
ABSTRACT | FULL TEXT  

Vascular Effects of Statins in Stroke
Delanty and Vaughan
Stroke 1997;28:2315-2320.
ABSTRACT | FULL TEXT  

Efficacy and Safety of a New Hydroxymethylglutaryl-Coenzyme A Reductase Inhibitor, Atorvastatin, in Patients with Combined Hyperlipidemia: Comparison with Fenofibrate
Ooi et al.
Arterioscler. Thromb. Vasc. Bio. 1997;17:1793-1799.
ABSTRACT | FULL TEXT  

Desaturation of Stearate Is Insufficient to Increase the Concentrations of Oleate in Cultured Rat Hepatocytes
Pai and Yeh
J. Nutr. 1997;127:753-757.
ABSTRACT | FULL TEXT  

Effectiveness of a Nurse-Based Intervention in a Community Practice on Patients' Dietary Fat Intake and Total Serum Cholesterol Level
Pine et al.
Arch Fam Med 1997;6:129-134.
ABSTRACT  

Lewis A. Conner Memorial Lecture: Oxidative Modification of LDL and Atherogenesis
Steinberg
Circulation 1997;95:1062-1071.
FULL TEXT  

Association of Elevated Serum Lipid Levels With Retinal Hard Exudate in Diabetic Retinopathy: Early Treatment Diabetic Retinopathy Study (ETDRS) Report 22
Chew et al.
Arch Ophthalmol 1996;114:1079-1084.
ABSTRACT  

Evaluating Cholesterol Screening: The Importance of Controlling for Regression to the Mean
Forrow et al.
Arch Intern Med 1995;155:2177-2184.
ABSTRACT  

Polyunsaturated fat and the risk of cancer
Willett
BMJ 1995;311:1239-1240.
FULL TEXT  

Metabolic Effects of Arginine in a Healthy Elderly Population
Hurson et al.
JPEN J Parenter Enteral Nutr 1995;19:227-230.
ABSTRACT  

Regulation of Hepatic 7alpha-Hydroxylase Expression and Response to Dietary Cholesterol in the Rat and Hamster
Horton et al.
J. Biol. Chem. 1995;270:5381-5387.
ABSTRACT | FULL TEXT  

Major Differences in Cardiovascular Risk Indicators by Educational Status: Results from a population based screening program
Gran
Scand J Public Health 1995;23:9-16.
ABSTRACT  

Problems With the Report of the Expert Panel on Blood Cholesterol Levels in Children and Adolescents
Newman et al.
Arch Pediatr Adolesc Med 1995;149:241-247.
ABSTRACT  

Cholesterol Reduction in Cardiovascular Disease -- Clinical Benefits and Possible Mechanisms
Levine et al.
NEJM 1995;332:512-521.
FULL TEXT  

An Overview of Trials of Cholesterol Lowering and Risk of Stroke
Hebert et al.
Arch Intern Med 1995;155:50-55.
ABSTRACT  

Population Based CVD Health Risk Appraisal: A method to create a "critical mass" of health-conscious people
Gran
Scand J Public Health 1994;22:256-263.
ABSTRACT  

Cholesterol and Violent Behavior
Santiago and Dalen
Arch Intern Med 1994;154:1317-1321.
ABSTRACT  

Comparative Efficacy and Safety of Micronized Fenofibrate and Simvastatin in Patients With Primary Type Ha or IIb Hyperlipidemia
Farnier et al.
Arch Intern Med 1994;154:441-449.
ABSTRACT  

Effectiveness of health checks conducted by nurses in primary care: results of the OXCHECK study after one year
Muir et al.
BMJ 1994;308:308-312.
ABSTRACT | FULL TEXT  

A Study of the Impact of Arabic Coffee Consumption on Serum Cholesterol
El Shabrawy Ali and Felimban
The Journal of the Royal Society for the Promotion of Health 1993;113:288-291.
 

State-Specific Changes in Cholesterol Screening--Behavioral Risk Factor Surveillance System, 1988-1991
JAMA 1993;270:1413-1414.
 

Declining Serum Total Cholesterol Levels Among US Adults: The National Health and Nutrition Examination Surveys
Johnson et al.
JAMA 1993;269:3002-3008.
ABSTRACT  

Total Serum Cholesterol Levels and Mortality Risk as a Function of Age: A Report Based on the Framingham Data
Kronmal et al.
Arch Intern Med 1993;153:1065-1073.
ABSTRACT  

Excess Body Weight: An Underrecognized Contributor to High Blood Cholesterol Levels in White American Men
Denke et al.
Arch Intern Med 1993;153:1093-1103.
ABSTRACT  

Molecular Medicine: A Spin-off From the Helix
Caskey
JAMA 1993;269:1986-1992.
ABSTRACT  

The Rationale for Lowering Serum Cholesterol Levels in American Children
Gidding
Arch Pediatr Adolesc Med 1993;147:386-392.
ABSTRACT  

Recent Trends in the Identification and Treatment of High Blood Cholesterol by Physicians: Progress and Missed Opportunities
Giles et al.
JAMA 1993;269:1133-1138.
ABSTRACT  

Improved Cholesterol-Related Knowledge and Behavior and Plasma Cholesterol Levels in Adults During the 1980s
Frank et al.
JAMA 1992;268:1566-1572.
ABSTRACT  

Patients' Knowledge About Fats and Cholesterol in the Community Cholesterol Survey Project
Kelly et al.
Arch Fam Med 1992;1:75-81.
ABSTRACT  

Serum Cholesterol Level and Mortality Findings for Men Screened in the Multiple Risk Factor Intervention Trial
Neaton et al.
Arch Intern Med 1992;152:1490-1500.
ABSTRACT  

Measuring and Knowing: The Trouble With Cholesterol and Decision Making
Gwynne
JAMA 1991;266:1696-1698.
ABSTRACT  

Health Risks of Self-Employment
LEWIN-EPSTEIN and YUCHTMAN-YAAR
Work and Occupations 1991;18:291-312.
ABSTRACT  

Hypocholesterolemic Effects of Different Bulk-Forming Hydrophilic Fibers as Adjuncts to Dietary Therapy in Mild to Moderate Hypercholesterolemia
Anderson et al.
Arch Intern Med 1991;151:1597-1602.
ABSTRACT  

Results of the Massachusetts Model Systems for Blood Cholesterol Screening Project
Havas et al.
JAMA 1991;266:375-381.
ABSTRACT  

Counseling Psychology in Health Settings: Promise and Challenge
Kaplan
The Counseling Psychologist 1991;19:376-381.
 

What If Americans Ate Less Fat? A Quantitative Estimate of the Effect on Mortality
Browner et al.
JAMA 1991;265:3285-3291.
ABSTRACT  

Lipoprotein-Cholesterol Analysis during Screening: Accuracy and Reliability
Bachorik et al.
ANN INTERN MED 1991;114:741-747.
ABSTRACT  

Change in Cholesterol Awareness and Action: Results From National Physician and Public Surveys
Schucker et al.
Arch Intern Med 1991;151:666-673.
ABSTRACT  

Myocardial infarction at a young age: mechanisms and management
Hamsten
Vasc Med 1991;2:45-60.
 

Study of the Effectiveness of a Health-Risk Reduction Program
Smith and Bobroff
Eval Health Prof 1991;14:88-99.
ABSTRACT  

Mortality in Acute Cerebral Infarction in Young Adults A Ten-Year Experience
Biller et al.
ANGIOLOGY 1991;42:224-230.
ABSTRACT  

Comparative Study of a Microporous Cholestyramine Analogue (Filicol) and Gemfibrozil for Treatment of Severe Primary Hypercholesterolemia: Short- and Long-term Results
Ros et al.
Arch Intern Med 1991;151:301-305.
ABSTRACT  

Genetic Defects in Lipoprotein Metabolism: Elevation of Atherogenic Lipoproteins Caused by Impaired Catabolism
Mahley et al.
JAMA 1991;265:78-83.
ABSTRACT  

Detection and Treatment of Elevated Blood Cholesterol: What Have We Learned?
Dalen
Arch Intern Med 1991;151:25-28.
ABSTRACT  

Family History Fails to Identify Many Children With Severe Hypercholesterolemia
Stare et al.
Arch Pediatr Adolesc Med 1991;145:61-64.
ABSTRACT  

Does Cholesterol Screening Result in Negative Labeling Effects? Results of the Massachusetts Model Systems for Blood Cholesterol Screening Project
Havas et al.
Arch Intern Med 1991;151:113-119.
ABSTRACT  

Relationship of Atherosclerosis in Young Men to Serum Lipoprotein Cholesterol Concentrations and Smoking: A Preliminary Report From the Pathobiological Determinants of Atherosclerosis in Youth (PDAY) Research Group
JAMA 1990;264:3018-3024.
ABSTRACT  

Use of Cholesterol Measurements in Childhood for the Prediction of Adult Hypercholesterolemia: The Muscatine Study
Lauer and Clarke
JAMA 1990;264:3034-3038.
ABSTRACT  

The Case Against Childhood Cholesterol Screening
Newman et al.
JAMA 1990;264:3039-3043.
ABSTRACT  

Lipoproteins and Atherogenesis: Current Concepts
Steinberg and Witztum
JAMA 1990;264:3047-3052.
ABSTRACT  

High Blood Cholesterol in Elderly Men and the Excess Risk for Coronary Heart Disease
Rubin et al.
ANN INTERN MED 1990;113:916-920.
ABSTRACT  

Impact of a Public Cholesterol Screening Program
Fischer et al.
Arch Intern Med 1990;150:2567-2572.
ABSTRACT  

Management of Cardiovascular Disease Risk Factors in Children: A National Survey of Primary Care Physicians
Kimm et al.
Arch Pediatr Adolesc Med 1990;144:967-972.
ABSTRACT  

Effectiveness of Low-Dose Lovastatin in Lowering Serum Cholesterol: Experience With 56 Patients
Bates et al.
Arch Intern Med 1990;150:1947-1950.
ABSTRACT  

Within-Person Fluctuations of Serum Cholesterol and Lipoproteins
Mogadam et al.
Arch Intern Med 1990;150:1645-1648.
ABSTRACT  

State-Specific Changes in Cholesterol Screening and Awareness--United States, 1987-1988
JAMA 1990;263:3133-3137.
 

Treatment of Hypercholesterolemia in the Elderly
Kafonek and Kwiterovich
ANN INTERN MED 1990;112:723-725.
ABSTRACT  

Hypercholesterolemia in Elderly Persons: Resolving the Treatment Dilemma
Denke and Grundy
ANN INTERN MED 1990;112:780-792.
ABSTRACT  

The Toledo Exercise and Diet Study: Results at 26 Weeks
Leighton et al.
Arch Intern Med 1990;150:1016-1020.
ABSTRACT  

Prescribed Use of Cholesterol-Lowering Drugs in the United States, 1978 Through 1988
Wysowski et al.
JAMA 1990;263:2185-2188.
ABSTRACT  

The Accuracy of Portable Cholesterol Analyzers in Public Screening Programs
Naughton et al.
JAMA 1990;263:1213-1217.
ABSTRACT  

How Reliably Can Compact Chemistry Analyzers Measure Lipids?
Kaufman et al.
JAMA 1990;263:1245-1249.
ABSTRACT  

Population-Based Frequency of Dyslipidemia Syndromes in Coronary-Prone Families in Utah
Williams et al.
Arch Intern Med 1990;150:582-588.
ABSTRACT  

Restaurant Menu Labeling: Impact of Nutrition Information on Entree Sales and Patron Attitudes
Albright et al.
Health Educ Behav 1990;17:157-167.
ABSTRACT  

Nutrition Update: Sugar and Fat Substitutes: The Challenge for Today and Tomorrow
Lynch
The Diabetes Educator 1990;16:101-105.
 

Effects of Exercise, Dietary Cholesterol, and Dietary Fat on Blood Lipids
Johnson and Greenland
Arch Intern Med 1990;150:137-141.
ABSTRACT  

The Purity of Cholestyramine Resin
Goldstein
JAMA 1989;262:3127-3127.
ABSTRACT  

Fish Oil Supplementation Does Not Lower Plasma Cholesterol in Men with Hypercholesterolemia: Results of a Randomized, Placebo-Controlled Crossover Study
Wilt et al.
ANN INTERN MED 1989;111:900-905.
ABSTRACT  

Physician Reaction to a Local Community Cholesterol Screening Program
Buchta et al.
Arch Intern Med 1989;149:2479-2481.
ABSTRACT  

Improvement in Family Physician Recognition and Treatment of Hypercholesterolemia
Madlon-Kay
Arch Intern Med 1989;149:1754-1755.
ABSTRACT  

Impact of National Guidelines for Cholesterol Risk Factor Screening: The Framingham Offspring Study
Wilson et al.
JAMA 1989;262:41-44.
ABSTRACT  

The Prevalence of High Blood Cholesterol Levels Among Adults in the United States
Sempos et al.
JAMA 1989;262:45-52.
ABSTRACT  

Cholesterol-Lowering Effects of Psyllium Hydrophilic Mucilloid: Adjunct Therapy to a Prudent Diet for Patients With Mild to Moderate Hypercholesterolemia
Bell et al.
JAMA 1989;261:3419-3423.
ABSTRACT  

Growth Failure: A Complication of Dietary Treatment of Hypercholesterolemia
Lifshitz and Moses
Arch Pediatr Adolesc Med 1989;143:537-542.
ABSTRACT  

Screening Asymptomatic Adults for Cardiac Risk Factors: The Serum Cholesterol Level
Garber et al.
ANN INTERN MED 1989;110:622-639.
ABSTRACT  

Physicians as Gatekeepers: The Impact of Financial Incentives
Clancy and Hillner
Arch Intern Med 1989;149:917-920.
ABSTRACT  

Physician Recognition and Treatment of Hypercholesterolemia
Landzberg and Heim
Arch Intern Med 1989;149:933-935.
ABSTRACT  

Primary Prevention of Chronic Disease among Children: The School-Based "Know Your Body" Intervention Trials
Walter
Health Educ Behav 1989;16:201-214.
 

Discretion Advised When Lowering the Serum Lipid Levels of Children
KAZANECKI et al.
Arch Pediatr Adolesc Med 1989;143:11-12.
ABSTRACT  

Lovastatin vs Cholestyramine Therapy for Primary Hypercholesterolemia-Reply
Tobert
JAMA 1988;260:3591-3591.
ABSTRACT  

Some Recent Advances in Nutrition
Bender
The Journal of the Royal Society for the Promotion of Health 1988;108:191-198.
 

Testing Cholesterol Accuracy: Performance of Several Common Laboratory Instruments
Koch et al.
JAMA 1988;260:2552-2557.
ABSTRACT  

Cholesterol and Coronary Heart Disease: The Importance of Patient-Specific Attributable Risk
Malenka and Baron
Arch Intern Med 1988;148:2247-2252.
ABSTRACT  

A Multicenter Comparison of Lovastatin and Cholestyramine Therapy for Severe Primary Hypercholesterolemia
The Lovastatin Study Group III
JAMA 1988;260:359-366.
ABSTRACT