"The Cholesterol Controversy: Who should be screened, and who should be treated? Atherosclerosis nutritionally is it just a cholesterol problem?"
Cholesterol is a public health concern. Since 1968 there has been a decline of about three percent per year in mortality rates for coronary heart disease (CHD), however, it still remains the major cause of death in the United States. The Adult Treatment Panel II of the National Cholesterol Education Program (NCEP) recognizes elevated serum total cholesterol levels, particularly with high levels of low-density lipoprotein (LDL) cholesterol, and low levels of high-density lipoprotein (HDL) as among the major risk factors contributing to CHD (12:171-173).
The 1990 data shows that approximately 52 million Americans 20 years or more are candidates for dietary intervention to reduce LDL levels by ten percent; seven percent may be candidates for cholesterol-lowering drugs. This data reflects around four million adults with CHD (half aged 65 years and older), and approximately 8.7 million adults without established CHD (3.1 million aged 65 years and older) (14:3009).
The Healthy People 2000 objectives for the nation in 1992 included recommendations for lowering CHD to include a dietary cholesterol intake not to exceed 300 mg/day. Also included was dietary fat intakes of 30 percent of total energy or less, saturated fat intakes of less than 10 percent total energy, increased complex carbohydrates and fiber-containing foods, and decreased sodium intake (12:171-3).
Atherosclerotic heart disease is the leading cause of death and disability in the United States despite the decline in deaths caused by cardiovascular disorders. Coronary atherosclerosis results in around 70 percent of all cardiovascular disease-related deaths, it is a major public health problem (1:973).
Atherosclerosis is a process involving the accumulation of lipids in the form of cholesterol esters and free c...