HDL Deficiency and Atherosclerosis

The discovery that plasma cholesterol and lipoprotein concentrations are major predictors of risk has been one of the most important factors behind the dramatic and steady reduction in deaths due to coronary heart disease seen over the last 30 years. However, although the significance of lipids is now well understood, we have yet to identify the ideal way to protect patients, particularly those with inherited lipoprotein disorders, against atherosclerosis. §New work described in this book sheds light on that important issue, especially on the role of the A apoproteins in HDL. For example, experimental gene transfer studies indicating that apoprotein A-1 may counteract the hyperlipidaemia and atherosclerosis found in apo-E deficiency suggest that we may soon be able to offer prophylaxis to patients whose risk of heart disease is greatly increased by a genetically-determined shortage of HDL. §The significance of a greater understanding of lipoproteins may even extend the cardiovascular field, as other research presented in this book illustrates; there is a growing interest, for example, in their effects on nervous tissue. Nevertheless, the most important goal remains the prevention of heart disease and the prospect of universal protection against premature atherosclerosis has never been brighter.