Critique of the Clinical Importance of Diuretic-Induced Hypokalemia and Elevated Cholesterol Levels

To the Editor.—In commenting on Dr Edward Freis' article, "Critique of the Clinical Importance of Diuretic Induced Hypokalemia and Elevated Cholesterol Levels,"¹ Dr Kaplan states that "diuretic induced hypercholesterolemia may persist, as shown in the Multiple Risk Factor Intervention Trial cohort and in smaller long-term studies." The smaller long-term study referred to by Dr Kaplan is that of Middeke and coworkers, ² which initially involved only 33 patients; at the end of 42 months, only 7 subjects remained. As noted in Table 1, cholesterol levels did increase from 5.98 to (Continued on p 2603.)

Table 1.—Serum Lipoproteins on Hydrochlorothiazide Subsets of Subjects— HAPPHY Study* Hydrochlorothiazide, Mo 0 (33) 42 (7) Cholesterol, mmol/L (mg/dL) HDL-cholesterol, mmol/L (mg/dL) LDL-cholesterol, mmol/L (mg/dL) Triglycerides, mmol/L (mg/dL) 5.98 (231)±43 1.1 (43)±13 4.03 (156)±38 1.78 (158)±74 7.22 (279)±76 1.18 (46)±13 4.88 (189)±63 2.48 (220)±116 *From Middeke and coworkers.1 HAPPHY indicates Heart Attack Primary Prevention