Causes of high blood cholesterol

This review indicates the complexity of the pathogenesis of hypercholesterolemia. Although dietary factors undoubtedly contribute to high LDL cholesterol levels in our society, the potential for genetic abnormalities in transport of plasma cholesterol is enormous. A multiplicity of processes affect each point of regulation, for example, synthesis and secretion of lipoproteins, apolipoprotein function, and clearance of LDL from the circulation. All of these modifying factors are under genetic control, and inherited defects in any of them may raise LDL cholesterol concentrations. In this regard, many people may have inherited enhanced sensitivity to dietary saturated fatty acids and cholesterol or to high caloric intake that combines with genetic defects to produce hypercholesterolemia. An understanding of the relative contributions of dietary, genetic, and secondary factors in the causation of hypercholesterolemia is critical for the development of a rational strategy for management of the "mass hypercholesterolemia" occurring in the US public.