Richard C. Pasternak, MD; Frank M. Sacks, MD
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Pasternak R., Sacks F.; Hypolipidemic Drugs in Coronary Artery Disease. Ann Intern Med. 1997;126:917. doi: 10.7326/0003-4819-126-11-199706010-00020
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Published: Ann Intern Med. 1997;126(11):917.
We appreciate the comments of Drs. Isley and Bittar. Both are correct in pointing out an error in our citation of the work of Stein and colleagues , which, in fact, compared simvastatin with cholestyramine and did not study the combination of the two drugs. We regret the misunderstanding.
With regard to Dr. Isley's other comments, we recognize that simvastatin is, in general, more potent than the statins that we had available at the time our study began. However, at the 40-mg pravastatin dose, the incremental effect of 40 mg of simvastatin on LDL cholesterol levels would be only about 4% to 6%. We agree that if a more potent statin had been available at the start of our study, fewer patients would have needed combination therapy to meet the National Cholesterol Education Program goal. Nevertheless, combination therapy would have been necessary to increase HDL cholesterol levels (affecting our LDL/HDL ratio goal) and to decrease triglyceride levels. We also reasoned that, in attempting to both minimize the cost and side effects of lipid therapy, information about combination therapy (such as the strategy we tested) will be useful to the practicing physician.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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