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Understanding atherosclerosis and its prevention remain high on the agenda of those interested in population health and those with the disease [1]. We know that the atherosclerosis plaque has at its core cholesterol deposits and that high serum cholesterol as found in Familial hypercholesterolaemia results in devastating early atherosclerosis and resultant myocardial infarction [2]. Separation of lipoproteins into various densities made it possible to investigate particle composition and the atherogenicity of the various particles. The lipoproteins apo B48 and B100 define the pro-atherogenic particles and apo A1 /A2 define the athero-protective lipoproteins. Excess dietary cholesterol was thought to be an important player in atherosclerosis and many important societies made recommendations to limit weekly intake to the detriment of the hen and seafood industries. Many years ago, an elderly man who had almost normal serum cholesterol levels was described because he remained well in spite of eating 20 plus eggs a day [3]. Now even the learned societies suggest that cholesterol in the diet should not be limited [4, 5]. In a similar vein, HDL cholesterol may no longer be described as the good cholesterol and raising HDL cholesterol may not be a goal in order to defeat atherosclerosis [6]. The art of Medicine is alive and well and the physician still has the duty and right to analyse ‘Consensus statements’ from learned societies!

current cardiology reviews

Commentary on High-density Lipoprotein Versus Low-density Lipoprotein Therapy and Cardiovascular Outcomes in Patients with Acute Coronary Syndromes by Nikolaos Papageorgiou et al.