Inflammation, Cholesterol Levels, and Risk of Mortality Among Patients Receiving Dialysis

To the Editor: Dr Liu and colleagues¹ reported that among patients receiving dialysis, cholesterol levels and mortality were inversely associated among patients with chronic inflammation but were positively associated in those without inflammation. The authors concluded that inverse relationships between cholesterol and mortality in previous studies of this population are due to the cholesterol-lowering effect of malnutrition and systemic inflammation, rather than to a protective effect of high cholesterol levels. However, there is considerable epidemiologic, clinical, and laboratory evidence that high cholesterol levels protect against infections, while low cholesterol levels predispose to infections.²