Cholesterol, Atherosclerosis, Ischemic Heart Disease, and Stroke

Abstract

Prospective epidemiologic studies have uniformly demonstrated that a high serum cholesterol level is predictive of increased risk of myocardial infarction or sudden death, but a relationship between cholesterol level and cerebral stroke has not been consistently found. Lowering of serum cholesterol concentrations may retard atherogenesis and delay some of its complications. A controlled clinical trial of a cholesterol-lowering diet in older men has resulted in a decreased combined incidence of myocardial infarction, sudden death, and cerebral infarction; the diet was more effective if started before age 66. Even though efforts to lower plasma cholesterol by pharmacologic inhibition of cholesterol biosynthesis have yielded discouraging results, there are sound reasons to attempt a new approach by inhibition of hepatic prenyl synthetase, the enzyme that catalyzes synthesis of farnesyl pyrophosphate.