Correspondence (letter to the editor): Low-Fat Diet and Exercise Are More Important

While reading this review and the editorial, I stumbled across the many conflicts of interest declared: All but one author of the review received financial contributions from almost all of the companies active in this field.

The group of familial hypercholesterolemias is diverse and certainly there is not one standard regimen that fits all. I have reasonable grounds for rejecting the doctrine of pharmacotherapy. Over the last 20 years, some of my patients with familial hypercholesterolemia have achieved cholesterol levels within the target range only by adhering to a strict vegetarian or even vegan diet, combined with weight reduction to normal weight and exercise.

Physicians are usually very strict with smokers: Patients who continue smoking (rightly!) do not get Prolastin and often no oxygen treatment either. In arteriosclerosis patients, a more conciliatory approach is taken, even though the best therapeutic option for them is to radically stop smoking (as in chronic obstructive pulmonary disease—COPD) and to reduce the dietary intake of animal fats to zero; complemented by pharmacotherapy, where required, and, of course, sports/exercise.