Is cholesterol and excess fat present in the blood of everyone with atherosclerosis? A study of 200 patients who had had heart attacks discovered that the great majority, and particularly those under 60, suffered from an excess of fats in their blood. Other patients who showed a normal level of cholesterol had other blood fat abnormalities. For it soon became clear that cholesterol was not the only important heralding factor announcing the approach or actual presence of atherosclerosis. Several other fat components were involved: beta lipoproteins, fat enzymes called cholesterol esterase, large fat globules circulating in the blood after a meal and special large complexes of fat molecules discovered by biophysicists.

At present we now know that excesses or abnormalities in any one or more of these five "public enemies" are directly connected with the production of a heart attack, a stroke, or other complication of atherosclerosis. It is therefore perfectly possible to have a normal cholesterol blood level and yet have some of the other above abnormalities

What about the factor of heredity? As research information piled up, another fact became clear. Of the 200 people studied, a substantial number had a family history of heart attacks or strokes. That is, members of their families were particularly susceptible to these two diseases. The patients seemed to be unfortunate links in a heredity chain. Later, it was discovered that in some cases an excess of cholesterol in the blood was an inborn error of fat metabolism. Inability of some people to handle fat in their systems made them especially prone to atherosclerosis.

When this atherosclerotic coat of arms has been handed down in a family, it is vitally necessary that double precautions be followed in strict adherence to the nutritional low-fat program.

Is there an excess of fat imbedded in the artery wall itself? The coronary artery that is damaged by an attack of atherosclerosis has four times as much cholesterol and fat content as that of the person who dies of causes other than heart attacks. Investigators both here and abroad corroborated that, tracking down the "killer" fat to his lair directly in the artery itself. They also noted that high blood pressure had the special effect of driving the cholesterol and fats into the artery wall with more speed and greater destructiveness than normal. Many patients with high blood pressure were particularly prone to heart attacks and strokes because of the extensive destruction wrought in their arteries by these fats.

Are there other conditions that cause heart attacks and strokes? To find the answer to this question a study of the hearts and arteries of 600 hospital patients who had died of various causes was made. After years of analysis it was able to report that in 100 cases of accidental death the great majority of men and women studied showed some degree of fatty deposits in their arteries. This was true in cases of people as young as 20, indicating that fat is a killer that has no respect for age. He often begins his work very early in a person's life.

In patients who were thin and wiry throughout their lifetime, the occurrence of atherosclerosis was generally much less than in all other cases.