A Medical Misdemeanor: I Harbored Evil Thoughts About the Fredrickson Fat Classification

Lawrence D. Grouse, MD, PhD
JAMA. 1980;244(18):2090-2091. doi:10.1001/jama.1980.03310180056039.
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Donald Fredrickson, MD, is one of my heroes even though his classification of hyperlipoproteinemias resulted in many unpleasant experiences for me. It began when the Fredrickson schema was presented during medical school, and certain confusing aspects of the classification suggested to me that it would not hold up over time. Occasionally, I would bet on the inherent shakiness of a theory by completely ignoring it; this strategy proved effective on numerous occasions in the more speculative research areas of medicine, somewhat less effective in subjects like anatomy, but the worst failure of my technique was in relation to the Fredrickson classification.

I cannot be blamed for skepticism concerning the classification. After all, of the five types of hyperlipoproteinemia (there are actually six classes, since type 2 comprises two subtypes, 2a and 2b), I was disturbed to learn that three were so rare as to be hardly worth considering. Worse than


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