Hypercholesterolemia deadly culprit in the cause of coronary vascular disease, but is it always, or even commonly, the cause of atherosclerosis? The answer is clearly not always, as other factors also play a role in the complex problem of how lipids accumulate in the tissues.
There is no question that hypercholesterolemia and hyperlipoproteinemia often result in the deposition of cholesterol in various tissues. This accumulation of cholesterol can take the form of either xanthomatosis or atherosclerosis. Cholesterol is carried in lipoproteins, particularly low-density lipoprotein (LDL) β-lipoprotein), very low-density lipoprotein (VLDL) (prebeta lipoprotein), and high-density lipoprotein (HDL) (α-lipoprotein). Various forms of xanthomas commonly develop in association with elevations in LDL and VLDL levels1 while HDL is thought to exert a protective effect against tissue cholesterol deposition by serving as a vehicle for transport of cholesterol from peripheral cells back to the liver. Low plasma concentration of HDL results in a defects of removal
Parker F. Normocholesterolemic Xanthomatosis. Arch Dermatol. 1986;122(11):1253-1257. doi:10.1001/archderm.1986.01660230045008