From the Editor-in-Chief

Abstract

In 2009, several trends are developing in the management of lipoproteins as contributors to the risk of arteriosclerotic vascular disease. I have specifically avoided the use of “lipoprotein disorders” as a term to describe the challenge before us. The risk of developing vascular disease in large populations is continuous and positively related to low-density and very–low-density lipoprotein concentrations throughout the range of values observed in surveys. If anything has become clear, the common human plasma concentrations of non-HDL and particularly LDL are contributing to the surreptitious development of this disease in virtually all residents of affluent nations. The improved economic conditions of countries that previously had a relatively low prevalence of this disease have been associated with a dramatic appearance of myocardial infarction and stroke. This has again demonstrated the power of lifestyle changes to shorten the period from birth to death in large numbers of our friends and neighbors. This should reaffirm the importance of developing low-cost and widely distributed interventions for reducing the quantity of these lipoproteins in the entire population. Reducing LDL and VLDL cholesterol only a few percentage points should reduce the incidence of coronary events by an equal percentage in a matter of 5 to 10 years. The lifetime effects of small changes will be even greater. The reduction of dietary soluble, gel forming, fiber is one of the changes that often accompanies increased economic status as animal products with higher fat and protein content replace vegetables, grains and fruit. The potential for improving lipoprotein concentrations by introducing natural beta-glucans or a chemically modified cellulose (hydroxypropylmethylcellulose) as dietary additives is the subject of two articles in this issue of the Journal. Although the reductions in LDL and VLDL cholesterol are small, applied in millions of people these small decrements in population distributions of these causative elements might pay benefits that amount to many thousands fewer hospitalizations and deaths from ischemic heart disease.