To the Editor.—
Contrary to the conclusion of Williams et al1 that persons with familial hypercholesterolemia should modify their diets to avoid early death from coronary heart disease, their findings show four forebears with hypercholesterolemia who probably ate ordinary diets but nevertheless lived normal life spans. Most important, perhaps, is that they were all nonsmokers.1Cigarette smoking is the juggernaut among environmental determinants of premature death from cancer and atherosclerotic cardiovascular disease,2 a fact that becomes readily apparent whenever well-quantified lifetime smoking experience3 is carefully weighed against lesser determinants such as lifetime dietary patterns.
Ravenholt RT. Familial Hypercholesterolemia and Early Coronary Death. JAMA. 1986;256(3):348. doi:10.1001/jama.1986.03380030050015