Reduction of cholesterol in Kentucky--a state at high risk.

Coronary artery disease (CAD) or coronary atherosclerosis mortality rates vary markedly in the different regions of the United States. It has been observed that the states bordering the Ohio and Mississippi Rivers have a dis-proportionately high coronary heart disease death rate. Kentucky is one of the most severely afflicted states, especially the eastern portion that includes the Appalachian region. The high CAD mortality rates in Kentucky are mainly due to a high prevalence of major traditional risk factors for coronary artery disease: elevated cholesterol, heavy cigarette smoking, and hypertension. Physical inactivity is also widespread. Attempts to reverse these risk factors have often failed for multiple reasons. Primary prevention is often not given priority by individuals because they have not, by definition, experienced any cardiac symptoms. Advice by physicians regarding treatments that can promote atherosclerosis regression and secondary prevention is suboptimal. A major campaign to educate patients and physicians about the importance of lowering cholesterol, dietary counseling, exercising, smoking cessation, and other interventions is essential. The ultimate methods of coronary atherosclerosis prevention will be through interventions at the cellular and subcellular levels. While such interventions are not yet available, major risk factor control and marked cholesterol reduction can be achieved and thereby significantly decrease the personal and economic suffering caused by coronary heart disease.