To the Editor.—
A multicenter study1 published in the July 15 issue of JAMA compared lovastatin and cholestyramine resin for treating severe primary hypercholesterolemia and concluded that lovastatin was both more effective and better tolerated. There is no argument that lovastatin is better tolerated than cholestyramine; however, I am not convinced that it is more effective.The Lipid Research Clinics Coronary Primary Prevention Trial2 and the more recently published Helsinki Heart Study3—both long-duration primary prevention trials—demonstrated that coronary heart disease morbidity and mortality can be reduced by favorably altering lipoprotein levels using cholestyramine in the former and gemfibrozil in the latter trial. Unfortunately, neither trial resulted in a decrease in overall mortality in the groups receiving drug treatment. Fifteen-year follow-up of a secondary prevention trial4 did reveal a decrease in coronary heart disease mortality and overall mortality in the niacin-treated group. Cholestyramine, gemfibrozil, and niacin
Goldstein MR. Lovastatin vs Cholestyramine Therapy for Primary Hypercholesterolemia. JAMA. 1988;260(24):3590–3591. doi:10.1001/jama.1988.03410240048025
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