We reported the proportion of women with established coronary heart disease (CHD) volunteering for the Heart and Estrogen/Progestin Replacement Study (HERS) who had reached the National Cholesterol Education treatment goals for LDL-C levels at the time of enrollment in 1993 and 1994. Only 37% had an LDL-C level at or below the 1988 goal (3.4 mmol/L [130 mg/dL]),1 and only 9% had a level less than the 1993 goal (2.6 mmol/L [100 mg/dL]).2 Dr Goldstein questions whether the evidence was sufficient to support more widespread or vigorous treatment of women than was observed.
This question raises a more fundamental issue about what type of data is sufficient to justify any therapy. Evidencebased medicine, referred to by Goldstein, stresses the use of clinical trials to support treatment recommendations by physicians. However, this emphasis must be tempered by the reality that even clinical trial data are incomplete. No form of
Schrott HG, Bittner V, Vittinghoff E, Hulley S, Herrington D. Evidence Supporting Cholesterol-Lowering Therapy for Postmenopausal Women With Heart Disease-Reply. JAMA. 1997;278(8):633-634. doi:10.1001/jama.1997.03550080043028