Angioscopy: Vascular and coronary applications

For many years hypercholesterolemia has been recognized as a risk factor for the development ofatherosclerosis. In recent years a mounting body of epidemiologic, experimental, and clinical data have clearly linked elevated plasma lipoproreins, particularly low-density lipoproteins, to coronary artery atherosclerosis. Recommendations have been made to the general population regarding ideal levels of serum cholesterol and strategies to achieve acceptable levels in patients with hypercholesterolemia. This book reports the proceedings of a symposium that addressed these important issues. The symposium, "Hypercholesrerolemia: Clinical and Therapeutic Implications," was held in Paris, France, on Dec. 4 and 5, 1987, and included well-recognized experts in the field from the United States and Europe. In the book the problem of hypercholesterolemia is addressed from basic mechanisms of lipoprotein metabolism and the effects oflipids on the artery wall to epidemiologic investigations and clinical trials of lowering serum cholesterol. The Framingham and other epidemiologic studies are reviewed and dearly identify total cholesterol and low-density lipoproreins as important predictors of cardiovascular disease and death. However, there is a marked age effect in this relationship with a strong relationship in young men and little predictive value in both sexes over the age of 50 years. Furthermore, whereas lipid levels are predictive of coronary heart disease, they contribute little or nothing to the prediction of transient ischemic attacks and stroke. The clinial primary prevention trials leading to the current American and European recommendations for the general public are reviewed in a dear and concise manner. Of note is the peculiar finding that although lowering cholesterol levels reduced ischemic heart disease, there was no increase in longevity. The rationale and strategies of dietary and drug treatment of hypercholesterolemia are well covered: Highly effective cholesterol-lowering agents, including lovastatin and simvastatiu, are discussed and compared to trials that used probucol and cholestyramine. The biochemical rationale, effectiveness, and early results of clinical trials are clearly presented. This is an important volume that represents the current state-of-the-art knowledge about hypercholesterolemia. It represents the evolution of many years of basic research to current clinical applications and public health issues. Since the risk of coronary artery disease faces us all, and since the potential for impacting on the disease with dietary and possible drug therapy is a reality, this is a very important volume for everyone to read. Christopher K. Zarins, MD University of Chicago