CLINICAL REVIEW Hypercholesterolaemia and its management

Hypercholesterolaemia is one of the major causes of atherosclerosis. Although there are many causes, hypercholesterolaemia is the permissive factor that allows other risk factors to operate. The incidence of coronary heart disease is usually lowwhere population plasma cholesterol concentrations are low. In Britain coronary heart disease is a major cause of mortality, and a recent Department of Health survey suggested that the average plasma cholesterol concentration in the United Kingdom was 5.9 mmol/l, much higher than the 4mmol/l seen in ruralChina and Japan,where heart disease is uncommon. Many studies before and after the introduction of statins have indicated that reducing theprevalenceofhypercholesterolaemia is an important means of decreasing coronary risk.