Cholesterol and its biological significance. Atherosclerosis. Statin therapy (part 1)

Despite the profound development of the theory explaining atherosclerosis pathogenesis, many questions still remain open. Modern ideas about the nature of atherosclerotic lesions in the vascular wall are largely based on the results of N.N. Anichkov’s research where hypercholesterolemia is considered the key point. Numerous theories of atherosclerosis have been proposed to date. However, the lipid-infiltrative idea, established over 100 years ago, remains dominant, and, despite the involved controversies, this concept lays the foundation for the therapeutic and preventive measures in cardiovascular diseases.Aim. The purpose of this review is to remind the reader of the biological significance of cholesterol, which performs essential vital functions in the body; to discuss some controversial points of view and contradictory facts regarding the etiological role of hypercholesterolemia in atherogenesis, which call into question the appropriateness of using blood cholesterol content as an indicator of disease severity and the possibility to assess the treatment effectiveness based on cholesterol level dynamics.