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To the Editor.—
We would like to reply to the letters published in the May 13, 1974, issue of The Journal concerning our article, "Massive Hyperlipemia During Estrogen Therapy" (227:522, 1974).As Dr. Applegate suggested, certainly caloric intake, the degree of saturated and unsaturated fats in the diet, ethanol, and free sugar intake are all very important determinants of serum cholesterol and triglyceride levels (Kuo PT, Ann Intern Med 68:449, 1968; Bortz WM, Metabolism 22:1507, 1973: Ginsberg H, et al, Ann Intern Med 80:143, 1974; Fredrickson DS, et al, N Engl J Med 276:32, 1967). While we do not deny the effects of weight loss and reduction of carbohydrates and saturated-fat intake in our cases 2 and 3, the decline in lipid levels from the extremely high levels in all four cases (especially cases 1 and 4, on whom no dietary restrictions were placed), when estrogen therapy was discontinued, to
Molitch ME, Oill PA, Odell WD. Hyperlipemia During Estrogen Therapy. JAMA. 1974;230(3):373-374. doi:10.1001/jama.1974.03240030015010