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To the Editor: We disagree with the hierarchy of messages from statin trials presented in the Editorial by Dr Cannon.¹ The fourth message for patients, which emphasized the importance of optimal use of diet and appropriate use of medications, should have been first and also should have been addressed to physicians. Moreover, the statement that the low-density lipoprotein cholesterol (LDL-C)–lowering effect of diet is only in the range of 7% to 12% may lead readers to underestimate the true effect of the dietary approach to chronic disease.

Adherence to healthy lifestyle practices has been associated with an 83% reduction in the rate of coronary heart disease, a 91% reduction in diabetes in women, and a 71% reduction in colon cancer in men.² Low consumption of fruit and vegetables and physical inactivity have been listed by the World Health Organization as among the top 10 causes of cardiovascular disease burden in . . . [Full Text of this Article]

Dario Giugliano, MD, PhD
dario.giugliano@unina2.it

Katherine Esposito, MD, PhD
Division of Metabolic Diseases
University of Naples
Naples, Italy

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