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To the Editor: The authors of ALLHAT-LLT¹ explored several possible reasons for the failure of lipid-lowering therapy to translate into any change in the risk of CHD. It is possible, however, that there may be a threshold value of the total cholesterol/HDL-C (high-density lipoprotein cholesterol) ratio, below which further lowering will not produce any significant reduction in CHD.² The average baseline ratios in several studies were greater than 5, which may be a critical value. Following treatment there was a significant reduction in CHD, especially in those studies that reported a ratio less than 5. Particularly noteworthy were the VA-HIT results, in which gemfibrozil produced a 24% decrease in CHD yet had no effect on LDL-C levels.³ The baseline ratio in ALLHAT-LLT was 4.67, so it is not surprising that further lowering of the ratio offered no CHD benefit. In the BIP study,⁴ a 41% reduction in CHD occurred in . . . [Full Text of this Article]

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