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Richard C. Keniston, MD
William Beaumont Army Medical Center El Paso, Tex

JAMA. 1989;261(22):3241-3242.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

To the Editor.—

In her commentary on cholesterol screening, Ms Merz¹ discusses the need for lipoprotein analysis, in addition to total cholesterol measurements. As a military pathologist, I have been involved with autopsies on four middle-aged men who have died of acute myocardial infarction while exercising. None of these men has had a total cholesterol level greater than 6.21 mmol/L by the Lipid Research Clinics method,² although the two with high-density lipoprotein cholesterol (HDL-C) values both had cholesterol/HDL-C ratios greater than 4.00, including the one with a total cholesterol level greater than 5.17 mmol/L. Since most patients who die of cardiovascular disease at this medical center also do not have elevated total cholesterol levels, I began to question the reliability of isolated total cholesterol measurements.

First, I looked at 1-month mortality in patients with cardiovascular disease who survived to admission and who had total cholesterol levels measured. Only . . . [Full Text PDF of this Article]

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