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Lower Is Better

Christopher P. Cannon, MD

JAMA. 2005;294:2492-2494.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

Three decades ago, the primary results of the Multiple Risk Factor Intervention Trial (MRFIT) were published in JAMA; that trial attempted to demonstrate benefits from lowering cholesterol (with diet) and managing other known risk factors for reducing cardiovascular morbidity and mortality.¹ Since then, multiple trials have shown cardiovascular benefit from lowering cholesterol, especially low-density lipoprotein cholesterol (LDL-C).^2-3 However, as of 1993, no trial had demonstrated a clear reduction in total mortality and, thus, debate still raged as to whether it was beneficial to reduce cholesterol.³

This changed when Pedersen and colleagues⁴ reported the landmark Scandinavian Simvastatin Survival Study (4S), which demonstrated that use of simvastatin, 20 to 40 mg/d, produced a highly significant 30% reduction in total mortality, in addition to reductions in myocardial infarction (MI) and the need for coronary revascularization. Subsequent trials expanded the benefit of treating broader groups of patients with statins,⁵ . . . [Full Text of this Article]

Author Affiliations: TIMI Study Group, Cardiovascular Division, Brigham and Women’s Hospital and Harvard Medical School, Boston, Mass.

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