In Reply Dr Borzak misunderstands our point about choosing a generic statin for cardiovascular risk reduction. Even if the benefits of statins are related entirely to lipid lowering—a point of controversy for some people—we cannot infer that every drug that lowers low density lipoprotein cholesterol (LDL-C) level will reduce risk. Drugs have many effects, and the influence on LDL-C may not convey whether patients will ultimately benefit. There are many examples when treatment of patients with drugs that lowered LDL-C level was not associated with better outcomes. For this reason, the clinical trial information is critically important and, at this point, we cannot say whether ezetimibe is a drug that improves patient outcomes. Statins are the only drugs with strong clinical trial evidence demonstrating improved patient outcomes.
Green JB, Ross JS, Krumholz HM, Good Stewardship Working Group of the National Physicians Alliance. The Case for Generic Statins: Not If They Don’t Work So Well—Reply. JAMA Intern Med. 2013;173(15):1474. doi:10.1001/jamainternmed.2013.7781