Lipoproteins, nutrition, aging, and atherosclerosis

Coronary heart disease (CHD) risk increases markedly with age in both men and women. Major risk factors for CHD in addition to diet and lifestyle factors include age, family history of CHD, cigarette smoking, hypertension, diabetes, elevated low-density-lipoprotein (LDL) cholesterol (> or = 4.1 mmol/L, or 160 mg/dL), and decreased high-density-lipoprotein (HDL) cholesterol (< 0.09 mmol/L, or 35 mg/dL). A diet containing < or = 30% of energy from fat, < 10% from saturated fat, and < 300 mg cholesterol/d for the general population for CHD risk reduction, and a further restriction of < 7% of energy from saturated fat and < 200 mg cholesterol/d for hypercholesterolemic subjects has been recommended. Such diets have been shown to reduce CHD risk. Age-adjusted CHD mortality rates have declined by 50% over the past four decades, probably because of decreases in animal fats in the diet, better control of hypertension, and efforts at smoking cessation.