Lipid Research Clinics Program

Abstract

To the Editor.— The outcome of the Lipid Research Clinics Trial 1 is clearly a landmark in medical history and, as such, is to be applauded. To be certain, however, that doubt has given way to certainty, one aspect of the study requires clarification: tendon xanthomata were not considered either in connection with the randomization or stratification of patients. 2 Tendon xanthomata are a marker for monogenic (receptor-defective or deficient) familial hypercholesterolemia (FH). 3 Their presence confers a risk of CHD morbidity and mortality many times greater than that of most patients with similar levels of LDL cholesterol who come from families without tendon xanthomata. 3-5 Certainly the cholestyramine and placebo groups in the trial were well matched for parental history of myocardial infarction or angina before the age of 60 years. 2 However, this is not a reliable means of identifying patients with monogenic FH, particularly if inherited from the