In the more than 50 years since the founding of the National Heart,
Lung, and Blood Institute and the American Heart Association, medical science
has moved from an era in which hypercholesterolemia, as it is now defined,
was not believed to be abnormal to one in which controlling hypercholesterolemia
is known to reduce not only coronary artery disease morbidity and mortality
but also total mortality. While the efforts and successes of many researchers
involved in this evolution are impressive, atherosclerosis is still a major
cause of death and disability in many developed nations, mostly in the form
of myocardial infarction and stroke, and is an increasing cause of morbidity
and mortality in developing nations. Many questions about the detailed pathogenesis
of the disease remain. Elucidating the roles of high-density lipoprotein,
other lipoproteins, and homocysteine, as well as the roles of cytokines and
growth factors, will permit better understanding and treatment of atherosclerosis.
With continuing support for research and encouragement of physicians and patients
to follow recommended preventive regimens, further progress can be made against
this major cause of death.