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November 28, 1986

Cholesterol and Coronary Heart Disease: A New Era

Author Affiliations

From the Center for Human Nutrition and the Departments of Clinical Nutrition, Internal Medicine, and Biochemistry, University of Texas Health Science Center at Dallas.

JAMA. 1986;256(20):2849-2858. doi:10.1001/jama.1986.03380200087027

SEVERAL important developments have recently given new impetus to prevention of coronary heart disease (CHD) through control of the plasma cholesterol level. Three advances have been particularly dramatic. First, the Nobel prize in medicine was awarded in 1985 to Drs Joseph Goldstein and Michael Brown for their discovery of cell-surface receptors for low-density lipoproteins (LDLs); their finding was fundamental to our understanding of how plasma cholesterol levels are controlled. Second, the Lipid Research Clinics (LRC) Coronary Primary Prevention Trial (CPPT)1 reported that lowering of the plasma cholesterol level by bile acid sequestrants reduces the frequency of several manifestations of CHD, including myocardial infarction. And third, a new class of cholesterollowering drugs, namely, competitive inhibitors of 3-hydroxy-3-methylglutaryl coenzyme A reductase, the rate-limiting enzyme in cholesterol synthesis, has been shown to markedly lower cholesterol levels.2-4 Although these inhibitors are not yet approved for clinical use, they reveal the potential for

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