To the Editor Green et al1(p229) make a case for generic statins as “the appropriate choice for dyslipidemic patients” but fail to consider the evidence as applied to high-risk subjects. While the authors correctly note that there is a very limited data set comparing one statin drug to another, their conclusion—that the data therefore support choosing the less-expensive drug—fails to consider the predominant mechanism of action: lowering low-density lipoprotein cholesterol (LDL-C) level. Considering the totality of trials evidence, the best meta-analysis shows that the clinical benefit of reducing hard end points in statin trials is most closely related to and best predicted by the decrease in LDL-C level from baseline.2 Consequently, in high-risk patients, the data support and guidelines call for a greater degree of LDL-C lowering,3 which can only be achieved through the use of atorvastatin, rosuvastatin, or high-dose simvastatin (which is no longer recommended by the Food and Drug Administration) and not by whatever generic statin is available.
Borzak S. The Case for Generic Statins: Not If They Don’t Work So Well. JAMA Intern Med. 2013;173(15):1473–1474. doi:10.1001/jamainternmed.2013.7798
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