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Comment & Response
January 2018

Simulation Models of Therapy Intensification in Lipid-Lowering MedicineFact or Fantasy?

Author Affiliations
  • 1Division of Cardiology, Department of Cardiothoracic and Respiratory Sciences, University of Campania “Luigi Vanvitelli,” A.O. dei Colli Monaldi Hospital, Naples, Italy
  • 2Unit of Internal Medicine, Department of Medicine, University of Perugia, Perugia, Italy
JAMA Cardiol. 2018;3(1):88-89. doi:10.1001/jamacardio.2017.4344

To the Editor We read with great interest the recent publication by Cannon et al1 regarding the intensification of lipid-lowering therapy in patients with cardiovascular disease. Developing an elegant simulation model, the authors reported that (1) most patients could achieve recommended low-density lipoprotein cholesterol level (LDL-C) goals through the intensification of oral lipid-lowering medication and (2) only a residual proportion of patients should require a proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor. The authors provide interesting data, exploring values and limits of modern lipid-lowering medicine and addressing the issue of PCSK9 inhibitors prescription. However, the authors have not considered in their model 2 relevant and quantifiable determinants of LDL-C values: statin intolerance and nonpharmacological interventions.

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