William L. Isley, MD
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Isley WL. Hypolipidemic Drugs in Coronary Artery Disease. Ann Intern Med. 1997;126:916. doi: 10.7326/0003-4819-126-11-199706010-00018
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Published: Ann Intern Med. 1997;126(11):916.
TO THE EDITOR:
Pasternak and colleagues  address the important question of the need for combination therapy in patients with coronary heart disease and “normal” cholesterol values. However, they imply in their introduction and discussion that the amount of low-density lipoprotein (LDL) cholesterol lowering achieved is similar for all currently approved 3-hydroxy-3-methylglutaryl coenzyme A (HMG CoA) reductase inhibitors (statins). Specifically, the authors ignore the well-known dose-response curves of these agents, as shown in two studies they cite in their article. The EXCEL (Expanded Clinical Evaluation of Lovastatin) study  clearly shows that lovastatin has an increasing effect as doses are increased from 20 mg daily (mean LDL cholesterol lowering, 24%) to 80 mg daily (mean LDL cholesterol lowering, 40%). Similarly, Stein and colleagues  showed mean LDL cholesterol lowering of 32% with a simvastatin dosage of 20 mg/d and of 40% with a dosage of 40 mg/d. (Pasternak and colleagues incorrectly give the results for cholestyramine alone as the results for resin plus simvastatin therapy.) The authors would probably have seen less need for combination therapy if they had used another statin at a dosage that would have achieved more LDL cholesterol lowering.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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