[Is elevated cholesterol the cause of arteriosclerosis?]

In post mortem studies the alterations produced by arteriosclerosis present a panorama of structural changes that defies the determination of an orderly sequence of events (Netter). Proliferation of fibromuscular vascular wall cell elements and over-production of extracellular matrix is quantitatively predominant. Lipid dispositions comprise less than 5% of the average plaque volume. Arteriosclerosis induced experimentally by cholesterol feeding and vessel wall traumatisation shows dependency in plaque composition from cholesterol feeding. The resulting vessel lumen narrowing is predominantly caused by overproliferation and equal with and without cholesterol feeding. The vision of arteriosclerosis as a "Proliferation disease" therefore appears more adequate than that as a "cholesterol storage disease". When patient groups are separated from coronary arteriography into those with normal coronary arteries and into those with coronary arteriosclerosis differences in cholesterol values are found below the age of 50 years, while above the age of 60 years no difference exists. In all groups the overlap is large and the individual risk can not be determined on the base of cholesterol levels. Between extend of angiographic changes and plasma lipid levels no correlation exists. Angiographic progression of disease which is closely correlated with clinical progression is independent of plasma cholesterol levels determined at the beginning of the observation period. The rate of restenosis after PTCA has been found to be independent of plasma cholesterol levels and can not be influenced by cholesterol lowering. In the report from the NHLBI on more than 600 000 individuals total mortality was independent from plasma cholesterol.(ABSTRACT TRUNCATED AT 250 WORDS)