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April 23/30, 2003

Lipid-Lowering Therapy and Risk of Coronary Events

JAMA. 2003;289(16):2070. doi:10.1001/jama.289.16.2070-a

To the Editor: The authors of the lipid-lowering trial component of the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT-LLT)1 reported that the prescription of 20 to 40 mg/d of pravastatin achieved a 17% reduction in low-density lipoprotein (LDL) cholesterol levels but did not produce any benefit in mortality or coronary heart disease (CHD) events after a mean follow-up of 4.8 years. The authors concluded that their data "should be interpreted as consistent with current recommendations for cholesterol control in the prevention and treatment of cardiovascular disease." Because current recommendations for cholesterol control for persons without known CHD2 are based on several key assumptions that were untested until ALLHAT-LLT, the negative results of this trial actually undermine these recommendations.

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