Lipids and Coronary Heart Disease



Summary Introduction

Cardiovascular disease, or coronary heart disease, is the most common cause of morbidity and mortality in the developed world; over the course of this century it will assume this dubious distinction in the developing world as well. Many factors contribute to heart disease, including age, gender, family history, hypertension, and diabetes: hyperlipidemia figures especially prominently as such a risk factor. The risk of coronary heart disease in any given individual increases with the number of risk factors in that person and the relative severity of each factor. This cumulative risk is multiplicative and not simply additive.

The detection of hyperlipidemia begins with the identification of patients at high risk for hyperlipidemia and/or coronary artery disease. During the evaluation process, the doctor must obtain a comprehensive dietary history of these patients, because those already at risk for the disease can increase their risk if they do not maintain an appropriate diet. Numerous guidelines have been published that suggest ranges of serum lipid moieties that correlate with relative risk of disease in individual patients. These guidelines form the basis for primary and secondary prevention efforts in clinical practice. Measurement or calculation of total cholesterol, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, and triglycerides is crucial to accurate risk assessment and the prescription of certain diets accordingly.

Excess dietary fat, perhaps especially saturated fat, contributes to prevalent serum hyperlipidemia in high-risk populations. Dietary interventions should serve as the mainstay of any attempt to reduce this burden of disease in individual patients and in the general population. These interventions should include the restriction of total fat, saturated fat, and cholesterol, and an increase in the intake of complex carbohydrates and high- fiber foods. Weight loss in overweight patients is a goal of a rational diet and contributes to important reductions in LDL cholesterol.