Public health aspects of serum cholesterol

Abstract

In the beginning of this century Anitschkow and De Langen started pioneering work concerning the relation between cholesterol and coronary heart disease. Both showed that there was a possible relation between cholesterol in the diet, blood cholesterol levels and atherosclerosis. It took until the second half of the twentieth century before large-scale population based studies, like the Framingham Study and the Seven Countries Study, were started to investigate the relation between serum cholesterol levels and coronary heart disease. These studies showed positive associations between serum cholesterol and incidence of and mortality from coronary heart disease in middle-aged men. Since then, other large epidemiological studies have shown that serum total cholesterol is positively associated and HDL cholesterol inversely associated with coronary heart disease mortality in middle-aged men. Quantifying the effect of cholesterol lowering interventions on for example incidence of coronary heart disease in The Netherlands is an important public health issue. Total cholesterol levels in the Dutch population are relatively high and did not substantially decrease until the beginning of the nineteen nineties. To quantify the amount of health gain that can be achieved through cholesterol lowering, additional information has to be gathered. First, recent levels of and trends in total and HDL cholesterol and prevalences of hypercholesterolemia and low HDL cholesterol levels in the Dutch population have to be described. Second, more evidence on the impact of total and HDL cholesterol on coronary heart disease in elderly men and women has to be collected. It is well known that serum total and HDL cholesterol are associated with coronary heart disease in middle-aged men and women, but it is still unclear whether this relation holds in the elderly. Third, risk functions to predict absolute risk of coronary heart disease in middle-aged men and women are well developed. However, in the elderly it is not clear whether these risk functions are a valid tool for risk prediction. This is important to know because cholesterol lowering treatment is nowadays based on the absolute level of risk, taking the total risk profile of an individual into account