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Since 1960, it has been clear that both blood pressure and serum cholesterol relate significantly and independently as major risk factors for epidemic coronary/cardiovascular disease, along with cigarette smoking. The overwhelming evidence on these readily measured major risk factors stimulated extensive and varied research on factors influencing serum cholesterol. It was shown that saturated fat, dietary cholesterol, and caloric imbalance leading to obesity all raised serum cholesterol; polyunsaturated fat and water-soluble fiber had opposite effects. These findings formed the basis for widely circulated recommendations for improving nutrition, and their adoption by wide sectors of the public accounts for the steady decline in adult population average serum cholesterol levels over the next decades. (Recently, trans fatty acids have also been shown to have adverse effects on serum cholesterol.)
Jeremiah Stamler, M.D., Northwestern
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