If cholesterol is the major cause of atheroma that obstructs the flow of blood in arteries of the heart and brain, significant morbidity and mortality from cardiovascular disease would be prevented by the aggressive lowering of total serum cholesterol and low-density lipoprotein (LDL) cholesterol. The complete occlusion of a coronary artery or cerebral artery is virtually always caused by a combination of atheromatous obstruction of the artery and subse¬quent rupture of the plaque of atheroma with thrombus formation on the ruptured material. Thus, the term atherothrombosis (see the chapter, Atherosclerosis/Athero-thrombosis).
Atherothrombotic cardiovascular disease causes more than 14 million deaths per year worldwide in a population of about 6 billion people. This is expected to increase to more than 25 million deaths by the year 2020 in a population of about 7.4 billion people. It is estimated that worldwide interventions could prevent more than one million deaths annually. The prevention of athe-roma is obviously more important to world health than the expensive production of so-called left ventricular assist devices, which are a bridge to heart transplantation.

CHOLESTEROL IS A LIPID, OR FAT-LIKE SUBSTANCE, made by animal cells. The role of an elevated blood cholesterol in causing a blockage to arteries by athero¬sclerosis and a subsequent myocardial infarction was a controversial issue from 1900 to 1994. Advice to patients during those 90 years was often half-hearted. Until recently we were not able to put the blame firmly on cholesterol and convince physicians and patients worldwide to aggressively lower serum cholesterol levels. The key piece

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