The Cholesterol Facts A

T he efforts of the National Cholesterol Education Program (NCEP) and the American Heart Association (AHA) to inform the public about the role of cholesterol in coronary heart disease (CHD) have recently come under criticism. The critics, popular magazine writers and a small group of physicians, suggest that the relation between cholesterol and CHD is not well defined, that lowering serum cholesterol does not extend life, that lowsaturated fat, low-cholesterol diets do little to reduce risk of CHD, and that lowering cholesterol levels is a waste of time and money. These comments have prompted some patients to question the need to adopt a lifestyle that includes a diet aimed at lowering serum cholesterol levels. The AHA and the National Heart, Lung, and Blood Institute (NHLBI) intend to remove doubts about the direct link between cholesterol and CHD. This statement reviews the epidemiologic, laboratory, and clinical studies that address questions most frequently asked about cholesterol: Is high serum cholesterol a risk factor for coronary heart disease? Will lowering serum cholesterol help prevent coronary heart disease? Will people live longer if their serum cholesterol levels are modified? Does management of high serum cholesterol provide benefit if coronary heart disease is already present? Will dietary change effectively lower cholesterol levels? Should age or gender change the approach to cholesterol management? Are cholesterol interventions cost-effective?