To the Editor.—
The case report by Handler and co-workers entitled "Symptomatic Coronary Artery Disease in a Marathon Runner" (1982; 248:717) is of considerable interest. The authors are right to challenge "the tempting illusion of invincibility in the runner." However, they are incorrect that there was an "absence of risk factors" in their patient.A high-density lipoprotein (HDL) cholesterol level of 51 mg/dL and a low-density lipoprotein (LDL) level of 94 mg/dL in the presence of a total cholesterol of 185 mg/dL means that this man had a very low-density lipoprotein level (VLDL) of 40 mg/dL. Although less attention has been given to VLDL levels than to LDL and HDL levels, there is evidence that an elevated VLDL level may also be a risk factor. In an angiographic study, Tan et al1 found the mean VLDL level in patients with coronary artery disease (CAD) was 37.7 ± 2.8 mg/dL
Gurewich V, Lapinska I. Symptomatic Coronary Artery Disease in a Marathon Runner. JAMA. 1983;249(7):881–882. doi:10.1001/jama.1983.03330310017005
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