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To the Editor: Dr Nissen and colleagues¹ argued that either total cholesterol or LDL cholesterol should be lowered as much as possible to prevent coronary heart disease. I disagree with this conclusion for several reasons.

First, the study was limited to patients with significant coronary heart disease. Second, pravastatin and atorvastatin have different effects on other relevant factors.² Third, a comparison was made only between moderate and extensive cholesterol lowering. Fourth, no dose-response relationship was noted for end points such as myocardial infarction or coronary mortality.

Although the authors found a correlation with lipid-lowering changes in plaque (using an intravascular ultrasound technique), this may have resulted from other effects of statins, such as reduction of inflammation or other effects on atherosclerosis rather than from lipid lowering.³ In fact, a dose-response relationship between degree of cholesterol lowering and outcome has not been demonstrated in most clinical and angiographic trials of statins.⁴ . . . [Full Text of this Article]

Paul J. Rosch, MD
stress124@optonline.net
Yonkers, NY

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