DRUGS OTHER THAN ANTICOAGULANTS IN TREATMENT OF ARTERIOSCLEROTIC HEART DISEASE

• Atherogenesis can be pictured as a process in which an inherited defect of arterial structure permits the development of atherosclerotic plaques under the influence of secondary factors such as hypertension, renal disease, and certain hormone imbalances. Drugs that alter the concentration of the blood lipids and lipoproteins have been studied as to their influence on this process; none of those tried by the authors, including sitosterol, have given convincing results. Data from three representative patients during periods longer than two years showed that normal variations of blood cholesterol values exceeded the changes attributable to sitosterol and that observations over shorter periods must give misleading results. A plan for the diagnosis and therapy of familial hyperlipemia is described, and in about 75% of the patients with this condition it has been controlled by a fat-free breakfast, a fat-free lunch, and no restriction on fat at the evening meal. The treatment of atherosclerosis, however, remains unsettled except that the patient's weight must be controlled and that secondary aggravating causes must be diligently searched for.