How to Manage a 36-Year-Old Man With Coronary Disease

To the Editor.— Dr Dunn's response to the question of how best to manage a 36year-old man with coronary artery disease¹ overlooked an important consideration. While this patient has risk factors for coronary artery disease (smoking, obesity, and hypertension), it is my opinion that any 36-year-old with advanced coronary atherosclerosis should be screened for elevation of serum lipid levels. Familial hypercholesterolemia and familial combined hyperlipidemia are common in those who present with coronary disease at an early age,² and although the efficacy of cholesterollowering treatment in the setting of advanced coronary artery disease remains controversial,³ identification of a lipid disorder in the patient described would be beneficial in several ways. First, it would affect the selection of the most appropriate antihypertension regimen (thiazides and β-blockers both lead to elevations of the low-density lipoprotein level). In addition, it would provide greater impetus to the patient to attempt to achieve