[Lowering of lipids: a true prevention?--a justified therapy?--a true controversy?]

Cholesterol and triglycerides are a measure of low density lipoprotein (LDL) and very low density lipoproteins (VLDL). These lipoproteins are of causal significance in atherosclerosis and cardiovascular diseases (CVD). High density lipoproteins (HDL) probably provide protection against atherosclerosis and CVD. Their concentration is, however, poorly reflected by total cholesterol which necessitate a direct determination of HDL-cholesterol. The HDL-C/total cholesterol quotient yields the best CVD risk prediction. True prophylaxis is given if serum lipid lowering leads to lower VLDL and LDL. Lipid lowering therapy diminishes the risk of CVD. In special cases, regression of atherosclerosis was observed under consequent lipid lowering therapy. Thus therapy is warranted. Some guidelines to lipid lowering therapy are given. The controversy surrounding lipid lowering therapy is in part a consequence of ignorance of the facts. More serious is the controversy as to whether atherosclerosis is a sequela of a single cause or of multifactorial origin. The latter view seems more probable and true prophylaxis will take other risk factors into account as well as lipid lowering measures.