July 7, 1969


Author Affiliations

Jackson Clinic and Foundation Madison, Wis

JAMA. 1969;209(1):113. doi:10.1001/jama.1969.03160140069023

To the Editor:—  In relation to Dr. Antonio Gotto's discussion on classification and management of familial hyperlipoproteinemia (207:929, 1969) I would like to offer some commentary.The discussion of therapy overlooks the fact that nicotinic acid is effective in most classes of hyperlipoproteinemia. It is definitely effective in types II and IV, probably in III and V, and perhaps even in type I. Its efficacy in types II, III, and IV has been noted by Fredrickson.1 Because it is effective without alteration of diet, dietary restrictions are unnecessary for many patients unless, of course, excessive weight is also present. In type IV, which is especially responsive to diet, nicotinic acid can be combined with diet if the latter alone is inadequate or if the patient is unwilling to adhere indefinitely to the degree of restriction necessary to achieve satisfactory lipid levels. In type IV patients with inadequate lipid