© 2019 Elsevier Inc. All rights reserved. In this chapter, the role of cholesterol and cardiovascular health is examined. It is clear that circulating lipoproteins are involved in the atherosclerotic process. The main classes of lipoproteins are introduced and will be explored further throughout the book. The concept of the Mediterranean diet pyramid is presented, along with the ¿French paradox¿ and the case study of Blue Zones, which are discussed as examples of lifestyles that defy the lipid hypothesis. It is concluded that the lipid hypothesis is not supported by many of the observed dietary patterns around the world. Further research is required in order to inhibit the real instigator and proliferator of cardiovascular disease (CVD), which is inflammation.