International Journal of Clinical Practice

Background: The prevalence of cardiovascular diseases, while lower than it once was, remains a significant health consideration.

Aims and Methods: To review the evolving evidence with respect to what role various factors play in the aetiology of coronary heart disease (CHD).

Results: While total cholesterol and low‐density lipoprotein cholesterol (LDL‐C) were previously believed to play central roles, it has now become clear that neither in isolation is highly significant. For example, some people with very high LDL‐C levels do not develop CHD, while others with very low LDL‐C levels do. Furthermore, there is a difference between dietary cholesterol and serum cholesterol. Dietary cholesterol, which is found in animal‐based foods, raises blood cholesterol in only approximately one‐third of people. Conversely, intake of saturated fatty acids and trans fatty acids can result in dyslipidaemia. Furthermore, obesity ‐ particularly abdominal obesity ‐ and metabolic syndrome both are strong independent risk factors for development of cardiovascular disease.

Conclusions: Statin therapy and a diet comprising a portfolio of plant sterols and viscous fibres can both significantly reduce LDL‐C levels and C‐reactive protein. The latter is a key marker of inflammation and of elevated risk for cardiovascular disease.