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Manual of Lipidology / Sujoy Ghosh, Banshi Saboo

First Edition: 2021

Over the last two centuries, the role of lipids in the development of cardiovascular disease (CVD) has gained significant attention, and specifically, the role of cholesterol on the development of atherosclerosis. The first studies involving cholesterol and CVD way back to the early 1900s when Anichkov, a pathologist, provided rabbits with high cholesterol diets and observed stiffening of their artery walls. The first lipid lowering medication, niacin, was discovered coincidentally after it was tested on a rabbit schizophrenia model. One of the side effects observed was lowering of cholesterol. In the late 1970s, a Japanese microbiologist Akira Endo first discovered natural products with a potent inhibitory effect on cholesterol synthesis in a fermentation broth of Penicillium citrinum, during his search for antimicrobial agents. Concurrently, Brown and Goldstein (later earning the Nobel Prize for their work in 1985) demonstrated that HMG-CoA reductase inhibition represented the rate limiting step in cholesterol biosynthesis. These early basic and translational studies led to the production of statins. The first of many statin trials to come was the 4S study conducted in Scandinavian countries in the late 1980s and showed a significant reduction in CV events. Of note, many subsequent trials confirmed the benefits of statins in reducing risk of heart disease. On another front, the publication on the Mediterranean diet in the mid-90s transformed our understandings of the dietary components that protect against heart disease. In that study, participants randomized to olive oil, nuts survived longer following coronary bypass surgery than individuals kept on their regular diet. Several dietary studies have been conducted since confirming a distinct role for fats in the pathogenesis of heart disease.