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April 23/30, 2003

Lipid-Lowering Therapy and Risk of Coronary Events—Reply

JAMA. 2003;289(16):2070. doi:10.1001/jama.289.16.2071-c

In Reply: In response to Dr Taylor and Dr Blakely, the ALLHAT investigators believe that our data provide no independent evidence that statin treatment is beneficial in older, hypertensive, moderately hypercholesterolemic patients, but that a number of other similarly large, long-term statin trials reported over the past 9 years do provide very persuasive evidence of reductions in mortality as well as CHD event rates. While population-specific explanations (the inclusion of large numbers of elderly patients, women, those with hypertension, etc) may explain our results when considered by themselves, they cannot be reconciled with the positive results of other large statin trials, which also included such patients but were blinded and attained more substantial cholesterol differentials between treated and control patients. Like Blakely, we therefore concluded that the most likely explanation for the apparent disparity in the results of ALLHAT-LLT and otherwise comparable placebo-controlled statin trials is the far smaller cholesterol difference between treated and control (usual care) patients, and we recommended that our results be viewed in the context of other statin trials as consistent with prior recommendations and guidelines on cholesterol lowering. Further analyses regarding effects in specific populations are under way as part of the Cholesterol-Lowering Trialists' Group collaboration.