Although the relation between cholesterol and atherosclerosis has been discussed for nearly 80 years, only in recent years has sufficient evidence accumulated to indicate without reasonable doubt that cholesterol plays a major role in the development of atherosclerotic plaques and therefore, symptomatic and fatal atherosclerotic coronary artery disease. This piece reviews the various factors linking cholesterol to atherosclerosis: 1) Feeding high cholesterol diets to certain non-human animals produces atherosclerotic plaques similar to those occurring in humans. 2) Cholesterol is found in both experimentally induced atherosclerotic plaques in non-human animals and in plaques in humans. 3) Atherosclerotic plaques large enough to produce clinical problems occur only in persons having serum or plasma total cholesterol levels for long periods of time more than 150 mg/dl. 4) The higher the blood total cholesterol level the greater the chance of having symptomatic and fatal atherosclerotic disease. 5) The higher the serum total and LDL cholesterol levels the greater the extent of the atherosclerotic plaques. 6) Lowering the blood total cholesterol and LDL cholesterol levels decreases the chances of fatal or non-fatal atherosclerotic disease. 7) Atherosclerotic plaques regress when high blood cholesterol levels are lowered.
