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To the Editor: Dr Nicholls and colleagues¹ found that treatment with statins was associated with regression of coronary atherosclerosis (assessed by intravascular ultrasonography) when low-density lipoprotein cholesterol (LDL-C) was substantially reduced and high-density lipoprotein cholesterol (HDL-C) was increased by more than 7.5%. The authors state that it remains to be determined whether these changes translate to improved clinical outcomes because the small increases in HDL-C observed during statin therapy have never been shown to correlate with clinical outcome.

However, in a post hoc analysis of the secondary coronary heart disease prevention Greek Atorvastatin Coronary Heart Disease Evaluation (GREACE) Study, the composite end point of all vascular events was found to be partly determined by the extent of atorvastatin-induced HDL-C increase in the structured care group compared with usual care.² This was in the setting of achieving an LDL-C level of 100 mg/dL (2.59 mmol/L) in 95% of patients in the . . . [Full Text of this Article]

Vasilios G. Athyros, MD
athyros@med.auth.gr

Anna Kakafika, MD; Asterios Karagiannis, MD
Aristotelian University
Thessaloniki, Greece

Dimitri P. Mikhailidis, MD, FFPM, FRCP, FRCPath
Royal Free University College Medical School
London, England

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