There is a serious lack of direct evidence that atherosclerosis is due to alterations in fat metabolism. Yet, the hypothesis is made attractive by various lines of reasoning—pathological, clinical, and epidemiologic. In its simplest form (fig. 1), the postulate states that some peculiarity of dietary fat leads to abnormalities in serum lipids that cause an accumulation of fat in blood vessel walls. Over many years the narrowing of certain vital vessels produces no recognizable disability until complete occlusion, often abetted by thrombosis, results in a sudden vascular accident. This occurrence is usually late in a long sequence of events. Many patients show massive degrees of atheromatosis at autopsy without having had clinical signs of coronary vessel involvement; conversely, some patients die of myocardial infarction secondary to a small localized coronary occlusion but show little generalized atheromatosis. Obviously many factors must be important at various stages in the genesis of this
Ahrens EH, Hirsch J, Insull W, Tsaltas TT, Blomstrand R, Peterson ML. DIETARY CONTROL OF SERUM LIPIDS IN RELATION TO ATHEROSCLEROSIS. JAMA. 1957;164(17):1905–1911. doi:10.1001/jama.1957.62980170017007d
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