Therapy for Low High-Density Lipoprotein Cholesterol in the Face of 'Desirable' Levels of Total Cholesterol

Abstract

<h3>To the Editor.—</h3> The National Cholesterol Education Program¹defines hypercholesterolemia as a total cholesterol level of 6.2 mmol/L or greater and borderline hypercholesterolemia as a serum total cholesterol level between 5.2 and 6.2 mmol/L. Desirable cholesterol levels are below 5.2 mmol/L. In the study by Drs Vega and Grundy,²"normolipidemic" patients (most of whom had coronary disease) with reduced high-density lipoprotein cholesterol were given pharmacologic agents to determine if elevations in high-density lipoprotein cholesterol levels could be achieved. This is an important issue, since low levels of high-density lipoprotein cholesterol are prevalent among patients with coronary artery disease even when cholesterol levels are below 5.2 mmol/L.³However, it is not clear from the study how "normolipidemia" was defined. Exclusion criteria included plasma total cholesterol levels greater than 6.47 mmol/L; based on this criterion,patients with borderline to high cholesterol levels qualified. Indeed, the concentration of plasma