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Atherosclerosis is considered to be caused by many risk factors. Epidemiological studies have shownthat the co-existence of multiple risk factors contributes to the progress in the disease more heavily than a single risk factor. A high level of LDLis a very strong risk factor for coronary heart disease (CHD), showing the high incidence of angina or myocardial infarction in familial hypercholesterolemia (FH). On the other hand, HDLis a negative risk factor for CHD.It was reported in epidemiological studies that a higher level of HDLcorrelates with a lower incidence of CHD.The mechanism for such an effect has been reported by several laboratories; the reverse cholesterol transport is enhanced by the addition of HDL, dose dependently in vitro. This result means that the accumulated cholesterol can be transported to plasma by HDL, which causes a decreased cholesterol content in cells and thus prevents foam cell formation. Therefore, it has been accepted that a higher level ofHDLis preferable for the prevention of CHD.Concerning the different functions of the two lipoproteins, LDLand HDL,it is very interesting to evaluate, the risk for CHDin patients presenting both high LDL and high HDL. These different functions from the aspect of atherogenecity or antiatherogenecity, were clinically studied in the patients with FH combined with cholesteryl ester transfer protein (CETP) deficiency. In this issue, Kamigaki et al reported a case of FH with CETP deficiency who did not show CHD(1).

Is Cholesteryl Ester Transfer Protein (CETP) Deficiency Atherogenic in Familial Hypercholesterolemia