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In Reply: I agree with Drs Giugliano and Esposito that a healthy diet is very important and that this is the first thing that physicians should address with their patients. It is also the initial intervention recommended by the Adult Treatment Panel III update.¹ However, diet generally produces only modest LDL-C reduction, varying between 7% and 14% in randomized trials.^2-3 In contrast, in the IDEAL trial, intensive statin therapy reduced LDL-C in statin-naive patients by around 50%.⁴

The data cited to support using diet to lower cardiovascular mortality risk are not from randomized studies and, therefore, indicate association rather than causation. Observational studies that have suggested benefit (such as these, or studies of other treatments, such as estrogen therapy⁵) often are not supported in subsequent randomized trials. This also appears to be the case with low-fat diet for which no benefit was found in a large randomized trial.⁶ Indeed, . . . [Full Text of this Article]

Christopher P. Cannon, MD
cpcannon@partners.org
TIMI Study Group
Boston, Mass

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