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A healthy lifestyle is repeatedly and explicitly mentioned as a first and basic measure to take and described in detail in the Lifestyle Measures section of our review. However, in familial hypercholesterolemia (FH), where it refers to an autosomal dominant hypercholesterolemia, the co-dominant transmission of functionally relevant mutations in the LDL (low density lipoprotein) receptor—less frequently apolipoprotein B or PCSK9 (proprotein convertase subtilisin/kexin type 9)—seriously limits the effect of diet on cholesterol levels; in homozygote or combined heterozygote patients, the effect of nutrition is virtually non-existent.
Polygenic hypercholesterolemias with a familial pattern have to be distinguished from FH; they respond much better to dietary changes and presumably explain the very good experiences described. In our review, we have covered the significant phenotypic variability observed in FH. We appreciate that these aspects were highlighted once again. However, we think that it is ethically problematic to refuse treatment in response to poor health behavior.
“Stumbling” across the “many conflicts of interest” reminds us that transparency can also be counterproductive, as a recent discussion in Deutsches Ärzteblatt has highlighted: ,, “Apparently doctors give undue importance to the conflict of interest statements,” said Lo. At the same time, they disregard scientific criteria...“ (1).
Prof. Dr. med. Gerald Klose
Praxis für Innere Medizin, Gastroenterologie,
Kardiologie und Präventionsmedizin, Bremen
Prof. Dr. med. Ulrich Laufs
Klinik Innere Medizin III
Universitätsklinikum des Saarlandes, Homburg
Prof. Dr. med. Winfried März
Medizinische Klinik V
Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim
Prof. Dr. med. Eberhard Windler
Präventive Medizin, Klinik und Poliklinik für Allgemeine und
Universitäres Herzzentrum Hamburg,
Universitätsklinikum Hamburg-Eppendorf, Hamburg
Conflict of interest statement
Prof. März is a partner of Synlab Holding GmbH. He has received consultancy fees; reimbursement of conference fees, travel expenses, and accommodation expenses; and fees for preparing continuing medical education events from Amgen Deutschland, Aegerion Pharma, Merck Sharp, Dohme Deutschland,Roche, Sanofi-Aventis, and Pfizer.
Prof. Klose has received consultancy fees from Amgen, Sanofi, MSD, Genzyme, and BMS. He has received fees for conference participation and reimbursement of travel and accommodation expenses from Sanofi and MSD. He has received fees for preparing continuing medical education events from MSD and BMS.
Prof. Laufs has received consultancy fees from Amgen, Sanofi, MSD, and Roche. He has received fees for conference participation and reimbursement of travel and accommodation expenses from MSD.
Prof. Windler declares that no conflict of interests exists.
|1.||Korzilius H: Interessenkonflikte in der Fortbildung, kritisches Denken ist gefragt. Dtsch Arztebl 2014; 111: 1546–7. VOLLTEXT|
|2.||Klose G, Laufs U, März W, Windler E: Familial hypercholesterolemia: developments in diagnosis and treatment. Dtsch Arztebl Int 2014; 111: 523–9. VOLLTEXT|