Surgery, drugs, lifestyle, and hyperlipidemia.

Heart disease is the number-one cause of death in the United States, and more money is spent on its treatment each year than for any other condition. Both epidemiologic and experimental data clearly show that elevated plasma cholesterol levels increase the risk of death from coronary heart disease. Genetic insufficiencies can cause high blood cholesterol, but most people with high cholesterol do not have genetic abnormalities; rather, they have lifestyles that include high-fat diets and little exercise. Cholesterol can be managed aggressively with coronary artery bypass surgery, percutaneous transluminal coronary angioplasty, partial ileal bypass, and even liver transplant. Antihyperlipidemic drugs include bile-acid-binding resins, nicotinic acid, fibric acid derivatives, hydroxymethyglutaryl coenzyme A-reductase inhibitors, and the antioxidant probucol. Strict programs of low-fat diets and exercise are also effective for reducing cholesterol, lowering blood pressure, and preventing heart disease without the side effects associated with surgery and drug therapy. Such lifestyle changes are critical to reducing the incidence of heart disease in this country.