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Comment & Response
August 12/26, 2013

The Case for Generic Statins: Not If They Don’t Work So Well—Reply

Author Affiliations
  • 1Cedars-Sinai Medicine, Department of Medicine, Cedars-Sinai Health System, Los Angeles, California
  • 2Section of General Internal Medicine, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
  • 3Center for Outcomes Research and Evaluation, Yale–New Haven Hospital, New Haven, Connecticut
  • 4Section of Health Policy and Administration, Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, Connecticut
  • 5Robert Wood Johnson Foundation Clinical Scholars Program, Yale University School of Medicine, New Haven, Connecticut
  • 6Section of Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
JAMA Intern Med. 2013;173(15):1474. doi:10.1001/jamainternmed.2013.7781

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.

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