Letters Section Editor: Stephen J. Lurie,
MD, PhD, Senior Editor.
In Reply: Dr Ravnskov and Drs Kalantar-Zadeh
and Anker argue that high cholesterol levels may confer protection against
infection and circulating lipopolysaccharides (ie, bacterial endotoxin) and
that hypercholesterolemia should not be treated among patients receiving dialysis.
Ravnskov cites the protective effects of dietary cholesterol supplementation
in children with Smith-Lemli-Opitz syndrome, in whom cholesterol levels are
extremely low (approximately 8-62 mg/dL [0.21-1.61 mmol/L]), as well as epidemiologic
findings that low total cholesterol levels (<160 mg/dL [4.14 mmol/L]) are
inversely associated with risk of infection. The latter associations in older
individuals (>55 years) or patients with chronic disease could result from
reverse causation. Frailty and subclinical disease can exist decades prior
to a clinical event.
Coresh J, Liu Y. Inflammation, Cholesterol Levels, and Risk of Mortality Among Patients Receiving Dialysis—Reply. JAMA. 2004;291(15):1833-1834. doi:10.1001/jama.291.15.1834-b