It seems unlikely that major and decisive advances in our understanding, prevention, and treatment of arteriosclerotic diseases will be made if concentration of research on dietary lipids and their effects continues. It is hard to see how the internal regulators, namely, enzymes and hormones, can be disregarded or given only a behind-the-scene place. They govern also the metabolism of lipids. It is therefore not too early that some attention has, more recently, been paid to enzymology in arteriosclerosis, both in respect to etiologyl-4 and treatment, 6. s and that the enzymatic constituents nicotinic acid and pyridoxin are becoming popular.The short remarks in the following paragraph will point out the inadequacies of the dietary lipid theories, since they are otherwise seldom, if ever, mentioned.(1) Relative freedom from coronary heart disease in certain populations, allegedly due to their low intake of fats, may be accompanied by a high incidence and a relatively severe degree of cerebral and aortic atherosclerosis in the same populations.'-9 In older age groups the race differences may be slight also in the case of coronary atherosclerosis.9 (2) The results of animal experimentation with lipids are inconclusive regarding man. This is self explanatory and repeatedly demonstrated in research. Concerning the widely used experimentation with rabbits it has been shownlo that the gradual exsanguination caused by the frequent withdrawals of blood samples for cholesterol determination is in itself sufficient to obtain hypercholesterolemia and some degree of atherosclerosis in the animals, without lipid feedings.(3) The definite sex difference in the severity of atherosclerosis before the age of 50 can hardly be explained by the dietary theories, particularly since a careful studyll has failed to detect any corresponding differences in the diet of the two sexes. (4) The observed relative freedom of at least some American Indian tribes from atherosclerosis in spite of their enjoyment of the same type of diet as other Americans cannot be reconciled with nutritional explanations. Testicular hormones have also been thought to aggravate or accelerate the development of atherosclerosis. Although this thought may seem attractive in younger age groups it seems quite alien in older people who suffer most from atherosclerosis. After the age of 50 there is a progressive and accelerated increase of atherosclerosis in both sexes, while at the same time the secretion of testicular hormones decreases progressively, even in men who did produce them well before. Also, women, completely lacking the testicular hormones, still develop atherosclerosis, at times even at an early age and in possession of apparently normally functioning ovaries. Although the rich supply of the ovarian estrogenic hormones in young women may explain their relative freedom from atherosclerosis, such an explanation would remain confined to the female sex, and, in the case of at least the Negro race, would not be valid even for this sex on the basis of recent repo...