You are here

Responses

Article menu

Download PDFPDF

APCU 38 Predictive factors for severe acute coronary syndrome (ACS) among good LDL achievers: uncovering hidden risks
Free
Compose a Response to This Article
Compose Response

More information about text formats

Plain text

  • No HTML tags allowed.
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.
Author Information
First or given name, e.g. 'Peter'.
Your last, or family, name, e.g. 'MacMoody'.
Your email address, e.g. higgs-boson@gmail.com
Your role and/or occupation, e.g. 'Orthopedic Surgeon'.
Your organization or institution (if applicable), e.g. 'Royal Free Hospital'.
Statement of Competing Interests

PLEASE NOTE:

  • A rapid response is a moderated but not peer reviewed online response to a published article in a BMJ journal; it will not receive a DOI and will not be indexed unless it is also republished as a Letter, Correspondence or as other content. Find out more about rapid responses.
  • We intend to post all responses which are approved by the Editor, within 14 days (BMJ Journals) or 24 hours (The BMJ), however timeframes cannot be guaranteed. Responses must comply with our requirements and should contribute substantially to the topic, but it is at our absolute discretion whether we publish a response, and we reserve the right to edit or remove responses before and after publication and also republish some or all in other BMJ publications, including third party local editions in other countries and languages
  • Our requirements are stated in our rapid response terms and conditions and must be read. These include ensuring that: i) you do not include any illustrative content including tables and graphs, ii) you do not include any information that includes specifics about any patients,iii) you do not include any original data, unless it has already been published in a peer reviewed journal and you have included a reference, iv) your response is lawful, not defamatory, original and accurate, v) you declare any competing interests, vi) you understand that your name and other personal details set out in our rapid response terms and conditions will be published with any responses we publish and vii) you understand that once a response is published, we may continue to publish your response and/or edit or remove it in the future.
  • By submitting this rapid response you are agreeing to our terms and conditions for rapid responses and understand that your personal data will be processed in accordance with those terms and our privacy notice.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.

Vertical Tabs

Other responses

Jump to comment:

  • Published on: 14 May 2025
    Mechanism linking low LDL cholesterol to severe acute coronary syndrome

    Dear Editor,

    The article "Mechanisms Linking Low LDL Cholesterol to Severe Acute Coronary Syndrome" provides a compelling exploration of the paradoxical association between low LDL-C and adverse outcomes in acute coronary syndrome (ACS), particularly in statin-naïve patients. The author here highlighting the critical mechanisms—immunometabolic dysfunction, lipoprotein oxidation, and inflammation—that may explain this phenomenon, challenging the conventional view that lower LDL-C universally confers cardiovascular protection.

    The discussion on immunometabolic dysfunction is particularly insightful, noting how inflammatory cytokines like IL-6 impair cholesterol efflux and promote a pro-inflammatory state (Libby, 2006). However, the article could further elucidate how low LDL-C specifically compromises immune cell function, such as T-cell membrane integrity, which is critical in ACS. Studies in sepsis, a comparable inflammatory state, suggest that hypocholesterolemia impairs immune responses, potentially paralleling ACS (Trinder et al., 2024).

    The role of oxidized LDL (oxLDL) in endothelial injury is well-articulated, with clear links to plaque destabilization (Keaney & Vita, 1995). Yet, the article misses an opportunity to discuss how low LDL-C might alter oxLDL production or clearance, which could be a key driver of the paradox. Additionally, the clinical implications section would benefit from actionable recommendations, such as integra...

    Show More
    Conflict of Interest:
    None declared.