On the basis of my own experience, I agree with the author: most patients with symptomatic atherosclerosis will have to be treated with statins. This is not because an appropriate diet is ineffective—as is the view often promulgated by the pharmaceutical industry, for obvious reasons—but because patients will insist that they adhere to the diet but rarely actually do so in practice. I am a vegetarian myself, and as a result of my own convictions, an above average proportion of my patients are also vegetarians or even vegans. I cannot spontaneously recall any of them who have clinically manifest atherosclerosis, and I have practiced as a specialist in internal medicine for almost 30 years. The cholesterol measurements of the vegetarians and vegans are below 200 mg/dl in 80% of cases, and there is therefore no indication for measuring LDL.
The problem is that cardiologists, angiologists, diabetologists, and endocrinologists/lipid specialists only ever get to see persons who consume an unhealthy diet and suffer the consequences, but who do not readily admit this. This distorts perceptions among the medical specialists mentioned above.
Dr. med. Peter Pommer
Abteilung für Pneumologie, Fachklinik Allgäu, Pfronten firstname.lastname@example.org
Conflict of interest statement
The author declares that no conflict of interest exists.
|1.||Parhofer KG: The treatment of disorders of lipid metabolism. Dtsch Arztebl Int 2016; 113: 261–8 VOLLTEXT|