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Following the recent episode of the “rosuvastatin-JUPITER controversy” in the Archives, a major issue—as correctly underlined by Pippin—is that most people taking a statin for the prevention of cardiovascular diseases actually do not benefit from this treatment. We also agree that the JUPITER controversy unfortunately masked the major question of how to efficiently reduce cardiovascular risk without taking cholesterol-lowering drugs.
Pippin proposes the adoption of a plant-based dietary pattern. We again agree that this strategy is probably better—both in terms of clinical efficiency and “side effects”—than taking a statin. Pippin backs his recommendation on the basis of the 52-nation INTERHEART study and the 2006 American Heart Association (AHA) Diet and Lifestyle Recommendations, as cited in his letter. However, evidence-based preventive medicine should primarily be based on randomized clinical trials. Neither INTERHEART (a case-control study) nor the 2006 AHA Recommendations (in which no clinical trial was cited) provide convincing evidence. This would reinforce the widespread idea that in the supposed absence of dietary trial, it is reassuring to use cholesterol-lowering drugs, despite the present statin controversy.
de Lorgeril M, Salen P, Rabeus M. Primary Prevention Cardiovascular Disease: Better Than Drugs—Reply. Arch Intern Med. 2010;170(20):1860-1861. doi:10.1001/archinternmed.2010.403