Since elevated levels of serum cholesterol are usually found in association with atherosclerosis, it seems reasonable that physiologic measures should be directed toward lowering the serum levels of cholesterol and related lipids. This reduction, presumably, would result in decreased formation and progression of atherosclerotic lesions.The presence of cholesterol and related lipids is essential to the normal functioning of the human subject. Therefore it would be unwise and nonphysiologic to rid the body completely of these compounds. Rather, a program should be adopted for the reduction of lipids to normal levels-supposedly a reflection of a return to normal cholesterol metabolism. Such a program might be expected to prevent the deposition of abnormal lipids in the blood vessels and reduce the existing atheromatous lesions.Several attempts have been made in this direction, and it is the purpose of this paper to present a review of current concepts. There are many reasons for believing that there is a connection between cholesterol metabolism and atherosclerosis. While we are awaiting the elaboration of this relationship by laboratory investigators, some of the therapeutic approaches to this problem can be applied.
UNSATURATED FATIf we accept the premise that a diet relatively deficient in polyunsaturated fat with a proportionately high level of saturated fats is an important factor in the development of atherosclerosis, then a recommendation for revision of the average American diet is in order. We might go further and say that if a regimen is available which will reduce rather than elevate the serum cholesterol level, it should be adopted. Kinsell's group (1) first pointed out that vegetable fats have a lipid-lowering effect. Prior to this observation, it was the vogue to eliminate cholesterol from the diet as completely as possible. This approach lost favor when it became apparent that there was an endogenous cholesterol formation which was probably more important than the exogenous intake. Also, at this time, certain investigators believed that dietary fats would elevate serum cholesterol and that this elevation was definitely atherogenic ; therefore, a low-fat diet was advantageous.This was the status of the situation prior to 1952, when Kinsell et al. made their observations-subsequently confirmed by Groen et al. ( 2 ) . With time,