To the Editor.—
It seems so logical, given the mass of epidemiologic data that correlates elevated cholesterol values with increased incidence of coronary disease in populations, that cholesterol must be the primary culprit and that a diet or drug that lowers cholesterol levels will a priori lower risk of death. If this is true, why haven't we been able to prove it?The article by Hoeg et al1 in the Jan 24/31 issue of JAMA is the position of believers. My own view of the data is more agnostic. The real question is very straightforward: does diet or drug therapy to lower lipid levels save lives? An affirmative answer remains elusive. If the diet or drug causes as many noncardiac deaths as it prevents cardiac deaths, that's no good. We need safe therapy with proved efficacy; we need a positive prospective study.There is still no prospective intervention trial that
Norenberg DD. The Management of Hyperlipoproteinemia. JAMA. 1986;255(21):2893–2894. doi:10.1001/jama.1986.03370210061009
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