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1. Lowering LDL and HDL with the same intervention

   • Matthew Menken, M.D., F.A.C.P.

   World Federation of Neurology Research Group on Medical Education

   The authors have added to our growing knowledge of the interventions by means of which to lower LDL cholesterol. However, the plant-based diet in this study also lowers HDL cholesterol. This is worrisome.

   It is not unusual in practice to encounter patients with LDL cholesterol values that exceed guideline recommendations (<80 mg/dL), yet who have progressive vascular disease. Conversely, it is rare in practice to encounter patients with very high HDL cholesterol values (>80 mg/dL), and who have progressive vascular disease.

   At the present time, we have few effective and well tolerated interventions to raise HDL cholesterol. Thus virtually all of the clinical research to date has focused upon lowering LDL cholesterol levels in defined populations. Plainly, comparable clinical studies to raise HDL cholesterol cannot yet be carried out.

   Until and unless such HDL cholesterol studies are done, we should limit LDL-lowering interventions in practice to those strategies that are HDL-neutral, or which raise HDL cholesterol at the same time.

   Conflict of Interest:

   None declared

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   Published May 6, 2005