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July 7, 2004

Aggressive Lipid-Lowering Therapy and Regression of Coronary Atheroma

JAMA. 2004;292(1):38. doi:10.1001/jama.292.1.39-a

To the Editor: Dr Nissen and colleagues1 reported that 80 mg of atorvastatin lowered LDL cholesterol to a greater degree than did 40 mg of pravastatin. I am concerned, however, that the study does not establish the rate of decrease over time. Although cholesterol was apparently measured every 3 months, the authors presented data only for baseline and 18 months. Similarly, the authors did not justify their use of linear regression analysis, which assumes a linear change over time. I am not convinced that that assumption is warranted in this case. It is possible, for instance, that pravastatin actually reduced LDL cholesterol to a greater degree early on in treatment.The time course would have implications for treatment. Perhaps it would be rational to begin with a faster-acting drug and then switch to a drug that is more potent in the long run.