Figure 1. “+” denotes the presence of so-called thrifty genes like those leading to hypercholesterolemia, “–“ denotes the absence of these genes. In the past (upper panel), carriers of thrifty genes were able to build comparably larger amounts of energy storage (orange bars) after feast episodes. In famine episodes, carriers of thrifty genes were therefore more likely to reproduce. Usually, people died before the negative consequences of metabolic profiles associated with thrifty genes became relevant. In contrast, today (lower panel), in the absence of famines, thrifty genes do not become relevant with respect to reproduction, but lead to traits of the metabolic syndrome, atherosclerosis, and earlier death due to atherosclerotic cardiovascular disease as the most common cause of death in Western societies.