The Cholesterol Hypothesis, also known as the Lipid Hypothesis, postulates a direct link between blood cholesterol levels and CHD. Studies show a higher and earlier occurrence of heart disease in patients with higher blood lipid levels. Strategies to decrease plasma lipid levels (primarily LDL - C) reduces CHD risk at the patient and population level. Although other CHD risk factors exist, the causal role of lipid accumulation in CHD pathogenesis has been shown in clinical, epidemiologic, and genetic analyses. Based on the strength of available evidence, is it time to rename the “Cholesterol Hypothesis” the “Cholesterol Principle”?