Hypercholesterolaemia: not all cases warrant treatment.

Increasing numbers of patients are being treated for hypercholesterolaemia on the basis of total cholesterol concentrations.We describe a 49 year old woman so treated whose high total cholesterol concentration was explained by a high density lipoprotein cholesterol concentration of 3-9 mmol/l and a serum apoprotein AI concentration of 2 75 g/l; this indicated hyper-a.lipoproteinaemia, a condition with no association with cardiovascular disease. Case reportFollowing routine health screening by her general practitioner a 49 year old woman was found to have a raised serum total cholesterol concentration of 9-4 mmol/l.She had not smoked for 15 years, was not diabetic, was of normal weight, took regular exercise, and had no family history of ischaemic heart disease.She had no symptoms suggestive of cardiovascular disease and on examination had no comeal arcus and tendinous or cutaneous xanthomas.Her electrocardiogram was normal.Her medical history included successful renal transplantation at the age of 37 and a total hysterectomy at the age of 45 followed by the start of hormone replacement treatment.One year later she was found to be moderately hypertensive and was started on a cardioselective l blocker (metoprolol).Her other medications were prednisolone (enteric coated) 10 mg twice daily, azathioprine 125 mg/day, and piperazine oestrone 1-5 mg/day.After the finding of hypercholesterolaemia she was placed on a cholesterol lowering diet and her total cholesterol concentration fell to 8-1 mmol/l over the next two months.No further reduction was achieved, however, and treatment with bezafibrate was started.Eight weeks later her cholesterol concentration remained at 8-2 mmol/l, and simvastatin 10 mg at night was substituted.This reduced her total cholesterol concentration to 7-1 mmol/l, where it fell within the range for triggering low density lipoprotein cholesterol estimation.