THE ROLE OF hypercholesterolemia, or more accurately hyperbetalipoproteinemia, as a risk factor for atherosclerosis in general and ischemic heart disease in particular is supported by a wealth of clinical, epidemiologic, and pathologic studies. A National Institutes of Health Consensus Development Panel recently concluded' that the ideal blood cholesterol for all Americans over the age of 30 is 200 mg dl or less, and that attempts should be made to lower blood cholesterol when it exceeds the 75th percentile, or approximately 240 mg dl, in middle-aged American men. Therapy should always start with a lipid-lowering diet, but diets acceptable to most patients typically lower blood cholesterol by 10% or less. Drug therapy has been limited by insufficient efficacy at tolerated doses, and in some cases a high instance of side effects and or significant safety problems.2 In individuals eating a typical Western diet, approximately one-third of total body cholesterol is derived.
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