Does Dietary Therapy for Hyperlipoproteinemia Type V Predispose to Premature Atherosclerosis?

Primary type V hyperlipoproteinemia is not usually associated with premature atherosclerosis. The patient described in this case report had typical clinical and biochemical features of type V hyperlipoproteinemia and was treated with a low-fat diet that led to abolishment of chylomicronemia, a decrease in plasma triglycerides, and an increase in low-density lipoprotein cholesterol. However, high-density lipoprotein cholesterol levels remained low. At the age of 42 years, after following the diet for 10 years, the patient sustained an acute myocardial infarction. It is suggested that dietary treatment may have accelerated coronary atherosclerosis in this patient by increasing the ratio of low-density to high-density lipoprotein cholesterol, thereby enhancing the atherogenicity of plasma lipoproteins.