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Publisher Summary This chapter provides an overview of public health aspects of optimal serum lipid–lipoprotein levels. It discusses why optimal serum lipid–lipoprotein levels are a major public health concern. The concern with the public health aspects of optimal serum lipid–lipoprotein levels stems from the key role of serum lipids–lipoproteins in the etiology and pathogenesis of the atherosclerotic diseases, especially the premature coronary heart disease (CHD) epidemic in the western industrialized countries. This is the key epidemic disease of modern times in western industrialized countries, particularly the United States. In these countries, in the era of their full development and economic maturity, irrespective of social system, it is the great white plague, replacing tuberculosis, which was the massive epidemic disease of the infancy and childhood of modern urban society. The chapter further reviews the societal roots of epidemic disease, the need and rationale for the primary prevention of the atherosclerotic diseases, and scientific evidence on the key role of rich diet and nonoptimal serum lipids–lipoproteins in the etiology and pathogenesis of epidemic atherosclerotic disease. Improved nutrition is the central public health issue regarding further progress toward optimal serum lipid–lipoprotein levels.

Publisher Summary This chapter presents a report of clinical–pathological section examined in the workshop. Present information from the clinicopathological studies outlined is clearly consistent with the epidemiological finding that atherosclerosis shows independent and opposing relationships with the plasma low-density lipoproteins (LDL)- and high-density lipoproteins (HDL)-cholesterol concentrations and that knowledge of both permits more accurate prediction of coronary risk than does the plasma total cholesterol level. The limited information at present available from clinicopathological studies suggests that the relationship of coronary artery stenosis and tissue cholesterol content to the HDL cholesterol level is continuous over a wide range of concentrations (25–100 mg/dl), without any clear threshold of concentration below which cholesterol deposition becomes particularly marked. The chapter discusses health statistics in populations with low lipid levels, cellular lipid requirements, kinetics of human intimal lipoprotein transport, regression of atheroma in man, lipoproteins and the familial aggregation of coronary heart disease, hypertriglyceridemia, lipoprotein and lipid responses to unifactorial and multifactorial dietary change, genetic variations of plasma lipids, physical activity and plasma lipoproteins, and plasma lipids and lipoproteins in a low-risk community in Naples, Italy.