Reducing High Blood Cholesterol Levels With Drugs-Reply

Kevin A. Shulman, MD; Harris Koffer, PharmD; Mary Kaye Willian, DrPH, RN; Bruce Kinosian, MD; Terry A. Jacobson, MD; Henry Glick, MA; John M. Eisenberg, MD
JAMA. 1991;265(15):1950. doi:10.1001/jama.1991.03460150053015.
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In Reply. —  Drs Bentkover, Boselli, and Lambird raise several issues concerning our article; the principal ones concern our construction of the LDL-HDL index, our analytic perspective, and the costs of side effects. We address these in turn.Dr Bentkover correctly observes that the LDL-HDL index reported in Table 1 (p 3028) does not appear well calibrated; it finds gemfibrozil ( —16) to be almost equivalent to cholestyramine resin ( —14), yet the two long-term trials for these agents indicate substantially different reductions in CHD risk (34% vs 19%). Dr Boselli also faults our first index, arguing that Gordon's1 observations indicate that elevations of HDL cholesterol levels and diminutions of LDL cholesterol levels have equivalent effects on CHD risk.Neither author notes that we report on a second index in our sensitivity analysis. This index is better calibrated with the long-term trials (gemfibrozil, —15.5; cholestyramine resin, —10.9) and equates the effects


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