Rodney A. Hayward, MD
Potential Conflicts of Interest: None disclosed.
Hayward RA. Does Age Modify Effectiveness of Statin Therapy in Coronary Artery Disease?. Ann Intern Med. 2010;152:825-826. doi: 10.7326/0003-4819-152-12-201006150-00019
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Published: Ann Intern Med. 2010;152(12):825-826.
We appreciate the comments from Drs. Pletcher and Coxson but respectfully disagree with their interpretation of the literature.
The meta-analysis by Lewington and colleagues (1) is not very relevant to our study. It combined observational studies of varying quality and completeness that were not treatment trials and thus do not reflect the effect of therapy on outcomes. Furthermore, these studies examined only mortality and did not include other cardiovascular events.
We are also confused about why Drs. Pletcher and Coxson refer to relative risks associated with total cholesterol level, which is a relatively poor predictor of ischemic heart disease, and did not report the non–statistically significant difference in the hazard ratios of total cholesterol to high-density lipoprotein cholesterol in persons aged 40 to 59 years versus persons aged 60 to 69 years, which was clearly the most powerful predictor in the study by Lewington and colleagues and is the measure used in our study. Furthermore, the meta-analysis from the Cholesterol Treatment Trialists' (CTT) Collaborators (2) did not find an age interaction for low-density lipoprotein cholesterol level. Finally, even if Drs. Pletcher and Coxson's hypothesis (that prediction tools, such as the Reynolds and Framingham risk scores, systematically under- or overpredict risk for CAD mortality by age) is someday found to be true, the appropriate reaction would be to recalibrate these prediction tools, not to change our tailored-treatment approach.
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