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April 17, 1991

Reducing High Blood Cholesterol Levels With Drugs

Author Affiliations

Arthur D. Little, Inc Cambridge, Mass

Arthur D. Little, Inc Cambridge, Mass

JAMA. 1991;265(15):1949. doi:10.1001/jama.1991.03460150053012

To the Editor.—  In their cost-effectiveness analysis of alternative pharmaceutical therapies for high blood cholesterol levels, Schulman et al1 do a good job of summarizing the literature relevant to a major national health goal, lowering total cholesterol and low-density lipoprotein cholesterol levels of 5% to 10% of middle-aged men in the United States plus an unidentified percentage of older men and women. However, one must be careful fully to understand the limitations of their methods before leaping to a position of advocacy concerning any programmatic policy measures that are alleged to reduce costs.First, as the authors point out in the first section of their article, serum cholesterol is used as a proxy for coronary heart disease (CHD) morbidity and mortality. Although there is no disagreement that high cholesterol levels put one at risk for an adverse CHD outcome, there is some variation in the relationship between unit or