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November 9, 1984

Lipid Research Clinics Program

Author Affiliations

University of Manchester Department of Medicine Manchester Royal Infirmary Manchester, England

JAMA. 1984;252(18):2547. doi:10.1001/jama.1984.03350180015015

To the Editor.—  The outcome of the Lipid Research Clinics Trial1 is clearly a landmark in medical history and, as such, is to be applauded. To be certain, however, that doubt has given way to certainty, one aspect of the study requires clarification: tendon xanthomata were not considered either in connection with the randomization or stratification of patients.2 Tendon xanthomata are a marker for monogenic (receptor-defective or deficient) familial hypercholesterolemia (FH).3 Their presence confers a risk of CHD morbidity and mortality many times greater than that of most patients with similar levels of LDL cholesterol who come from families without tendon xanthomata.3-5Certainly the cholestyramine and placebo groups in the trial were well matched for parental history of myocardial infarction or angina before the age of 60 years.2 However, this is not a reliable means of identifying patients with monogenic FH, particularly if inherited from the