Paul P. Glasziou, MBBS, PhD; Les Irwig, MBBS, PhD
Potential Financial Conflicts of Interest: None disclosed.
Glasziou P., Irwig L.; Monitoring Cholesterol Levels: Understanding Variance and Finding the Most Useful Data. Ann Intern Med. 2008;149:437. doi: 10.7326/0003-4819-149-6-200809160-00020
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Published: Ann Intern Med. 2008;149(6):437.
We thank Dr. Timbie for the 2 corrections. All our calculations and writing were done in mmol/L, but we added the U.S. units (mg/dL) in our revision and did this incorrectly for variances (although SDs and means are correct).
Dr. Cayley points out that most of the statin trials have used a fixed dose (4S [Scandinavian Simvastatin Survival Study] is an exception) rather than monitoring-based titration or adjustment. As our work demonstrates, trials with a fixed dose allow the opportunity to assess how cholesterol values increase over time. In patients who truly have a substantial increase, a change in treatment can be considered. Inferences can then be made about monitoring-based titration or adjustment, but we do not believe practice must exactly echo the trials, which are designed for maximum power rather than optimal practice.
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