Cardiovascular diseases are the leading cause of mortality in the industrialized world. together accounting for about one-half of the total number of annual deaths. Coronary heart disease comprises about one·half of the cardiovascular mortality and cerebrovascular disease about one-quarter. Diseases of the circulation not only result in many lost years of life. but they also compromise the quality of life considerably. The main cause of cardiovascular diseases is atherosclerosis. Many factors are implicated in atherogenesis. but serum lipids and especially serum cholesterol appear to play an essential role. In biochemical studies cholesterol was found to be the principal lipid ingredient of the atherosclerotic lesion.,.. In animal experiments it was shown that feeding cholesterol was necessary to produce major atherosclerotic lesions 5 ·6 Clinical studies showed that patients with coronary heart disease had higher serum cholesterol concentrations than those free of this disease. 7 •8 Epidemiological investigations revealed positive relations between serum cholesterol levels and the prevalence and incidence of coronary hean disease in both cross-sectional and longitudinal studies

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The EPOZ study. from which most of the data in this thesis are derived. has been supported by generous grants from the Netherlands Prevention Fund. Financial support by the Netherlands Heart Foundation. The Hague. and by Merck. Sharp & Dohme BV. Haarlem. for the publication of this thesis is gratefully acknowledged.
H.A. Valkenburg (Hans)
Erasmus University Rotterdam
Erasmus MC: University Medical Center Rotterdam