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Not-so-hyper hyperlipo-proteinemia and coronary artery disease.

Atherosclerosis is the leading cause of death in the United States, and its prevention is now a primary goal of health care personnel. Knowledge of the early history of the disease, which would be particularly helpful in determing its pathogenesis, is still lacking. Studies are only now beginning to be directed at younger individuals without clinical evidence of disease. Hyperlipoproteinemia has been considered a definite risk factor for atherosclerosis for some years, but because of the difficulty involved in relating specific lipid abnormalities to the extent of atherosclerosis in a given patient, unequivocal proof of its role is lacking. Serum lipid and lipoprotein levels used to define hyperlipoproteinemia in the United States are derived from a system in which 95% of the population are regarded as having normal levels. The cut points are set far too high. Mild hyperlipoproteinemia is rampant in this country, as is coronary artery disease, and from the evidence now available, it seems reasonable to try to lower the incidence of the latter by reducing blood lipid levels of the entire population through dietary modification.