V.N. Коvalenko, Т.V. Tаlаeva, V.V. Bratus Cholesterol and atherosclerosis: traditional views and contemporary ideas

According to the contemporary views, pathogenesis of atherosclerosis has complex nature with involvement of both lipid and non-lipid factors in development and progression of the process and determination of its clinical course. Nevertheless so far, especially in clinical practice, the unitary – cholesterol hypothesis of atherosclerosis did not loose its value. Diagnosis, primary and secondary prevention, pharmacotherapy of atherosclerosis are based on interventions which promote the lowering of blood cholesterol. However, currently the most prevalent type of atherogenesis combined with obesity, metabolic syndrome, insulin-independent diabetes mellitus develops in absence of hypercholesterolemia. Therefore, problems of diagnosis and treatment of such patients are still unresolved. In the work based on the results of contemporary research and original investigations we analyzed the pathogenetic significance and value of main atherogenic factors. It was shown that severe coronary atherosclerosis leading to myocardial infarction may appear on the background of normal values of total cholesterol and low density lipoprotein cholesterol. Proatherogenic dyslipidemia, systemic inflammation, atherogenic and immunogenic lipoprotein modification were marked at background of normal and even low levels of cholesterol. Though hypercholesterolemia is a significant and undisputable marker of atherosclerosis, its absence does not afford to exclude the presence of atherosclerosis. Thus the results of the investigation confirm the insufficient value of total blood cholesterol as index of atherosclerosis, intensity of its progression and necessity of more deep analysis of atherogenic factors for the evaluation of the risk of ischemic heart disease and effectiveness of the treatment

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