Cholesterol and coronary heart disease. Future directions
S. M. Grundy
Department of Biochemistry, University of Texas Southwestern Medical Center, Dallas 75235-9052.
The importance of high serum cholesterol levels as a risk factor for
coronary heart disease and the benefit of lowering cholesterol levels for
reducing risk are being increasingly accepted. A broad consensus to this
effect has led to the establishment of the National Cholesterol Education
Program. Although the available evidence fully justifies this program, its
practical application to the American public has generated a series of new
questions that must be explored. For example, it can be questioned whether
reduction in coronary risk through lowering cholesterol levels extends to
both sexes and all age groups. For people with high cholesterol levels,
dietary modification is undoubtedly the first step of management, but the
fraction of people responding adequately to dietary change remains to be
determined. Finally, indications for drug therapy and choice of drugs need
further exploration, particularly in the area of cost vs benefit. Thus,
continuing research must be carried out in parallel with clinical and
public health application of cholesterol education.
