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April 17, 2018

Challenges in Interpreting the Lipid-Lowering Trials: Biology vs Ecology

Author Affiliations
  • 1Duke Clinical Research Institute, Durham, North Carolina
  • 2Duke University Medical Center, Durham, North Carolina
  • 3Associate Editor, JAMA
JAMA. 2018;319(15):1549-1551. doi:10.1001/jama.2018.4041

The past quarter century has witnessed a series of randomized clinical trials that defined contemporary cholesterol treatment algorithms. The first two of these trials, WOSCOPS and 4S, demonstrated the efficacy of statin therapy vs placebo in persons with very elevated low-density lipoprotein cholesterol (LDL-C) levels ( ≈ 190 mg/dL).1,2 Subsequent studies identified the benefits of statin therapy in populations with progressively lower starting LDL-C levels. As equipoise shifted, trial designs changed from placebo-controlled interventions to evaluating more- vs less-intensive lipid-lowering strategies.

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