To the Editor: In their study of very high-intensity statin therapy, Dr Nissen and colleagues1 found that use of a high-dose statin may be able to reverse atherosclerosis. However, I am concerned about statements in the article such as “regression was achieved by reducing LDL-C” that imply that it was changes in low-density lipoprotein cholesterol (LDL-C) or high-density lipoprotein cholesterol (HDL-C) that were responsible for the observed plaque regressions.
This study showed only that giving rosuvastatin at 40 mg/d on average produced plaque regressions, large reductions in LDL-C levels, and modest increases in HDL-C levels; it did not show a causal link among these 3 findings. Whether it was the low LDL-C, the increase in HDL-C, some combination of these, or none of these but some other action of the drug (eg, pleiotropic effects) that was responsible cannot be inferred from the results reported. Table 4 in the article indicates little association between HDL-C and atheroma regression and little evidence of a graded association between LDL-C and atheroma regression. While the LDL-C results for median percent atheroma volume (PAV) changes seemed consistent with lower LDL-C being associated with greater reduction, the median changes in atheroma volume in the most diseased 10-mm segment for patients with LDL-C levels above and below the mean were in the wrong direction, while results for those with LDL-C levels of less than 70 mg/dL, 70 to 100 mg/dL, and greater than 100 mg/dL were not consistent with lower being more beneficial. Elsewhere, Nissen has cautioned that the beneficial effects of statins might be due to properties other than their LDL-C effects.2
Thus, until further investigations are undertaken, the findings of this study should not be taken as evidence that it was the cholesterol changes per se that were responsible for the atheroma reductions.
Financial Disclosures: None reported.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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