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August 27, 1997

Evidence Supporting Cholesterol-Lowering Therapy for Postmenopausal Women With Heart Disease

Author Affiliations

Crozer-Chester Medical Center Upland, Pa

JAMA. 1997;278(8):633. doi:10.1001/jama.1997.03550080043027

To the Editor.  —Dr Schrott and colleagues1 suggest that women with established coronary heart disease have been undertreated for elevated low-density lipoprotein cholesterol (LDLC) levels based on screening data from the Heart and Estrogen/ Progestin Replacement Study (HERS). However, evidencebased medicine suggests the women were adequately treated.At screening, nearly half of the participants of the trial were taking cholesterol-lowering medication. The suggestion that women were undertreated was based on the failure of a majority of the HERS cohort to have achieved LDL-C goals set by the National Cholesterol Education Program (NCEP) adult treatment panel in 19882 and 1993.3 Those goals were derived from trials involving men and extrapolated to women. The screening for HERS ended in September 1994, before evidence-based medicine suggested that women might benefit from cholesterol lowering. The Scandinavian Simvastatin Survival Study (4S)4 and the Cholesterol and Recurrent Events (CARE) trial5 were