To the Editor: Dr Nissen and colleagues1 argued that either total cholesterol or LDL cholesterol
should be lowered as much as possible to prevent coronary heart disease. I
disagree with this conclusion for several reasons.
First, the study was limited to patients with significant coronary heart
disease. Second, pravastatin and atorvastatin have different effects on other
relevant factors.2 Third, a comparison was
made only between moderate and extensive cholesterol lowering. Fourth, no
dose-response relationship was noted for end points such as myocardial infarction
or coronary mortality.
Rosch PJ. Aggressive Lipid-Lowering Therapy and Regression of Coronary Atheroma. JAMA. 2004;292(1):38. doi:10.1001/jama.292.1.38-b