Cholesterol as a risk factor for coronary heart disease

The intense current interest in lipids as causal risk factors in coronary heart disease has encouraged a unifactorial, one-dimensional approach to coronary risk based on fixed total serum cholesterol or low density lipoprotein (LDL) cholesterol cut-points. Epidemiological evidence shows that coronary heart disease risk is multifactorial; the risk associated with a given lipid value is modulated overwhelmingly by the level or presence of other factors. While populations with high lipid values may be characterized as being at high risk, individual risk cannot be determined by isolated lipid measurements. To characterize individuals as at high or low risk by considering lipid values alone results in serious misclassification. Cut-points derived from middle-aged American men create anomalies when applied to different age and sex groups and to different populations. Clinical management of risk factors in individuals should involve the negotiation of a flexible and multi-dimensional individual regime, comprising all modifiable factors.