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October 18, 2006

High-Dose Statins and Atherosclerosis Regression—Reply

Author Affiliations

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2006;296(15):1836-1837. doi:10.1001/jama.296.15.1837-b

In Reply: Dr Port challenges our conclusion that the regression observed in the ASTEROID trial was related to changes in LDL-C and HDL-C levels. We strongly disagree. Atherosclerosis imaging studies using coronary angiography, carotid ultrasound, and intravascular ultrasound have been performed for nearly 2 decades.13 Benefits have consistently been proportional to the extent of reduction of LDL-C or the increase of HDL-C. These benefits have been observed for several different classes of therapeutic agents, including bile acid resins, nicotinic acid, and statins. While it is true that many researchers (including us4) have reported “pleiotropic” effects of statins, there is no scientific basis to suggest that these effects are the dominant factor in determining disease progression rates. We think the overwhelming body of evidence supports the conclusion that LDL-C is the most important determinant of progression rate.

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