To the Editor: Dr Nicholls and colleagues1 found that treatment with statins was associated with regression of coronary atherosclerosis (assessed by intravascular ultrasonography) when low-density lipoprotein cholesterol (LDL-C) was substantially reduced and high-density lipoprotein cholesterol (HDL-C) was increased by more than 7.5%. The authors state that it remains to be determined whether these changes translate to improved clinical outcomes because the small increases in HDL-C observed during statin therapy have never been shown to correlate with clinical outcome.
However, in a post hoc analysis of the secondary coronary heart disease prevention Greek Atorvastatin Coronary Heart Disease Evaluation (GREACE) Study, the composite end point of all vascular events was found to be partly determined by the extent of atorvastatin-induced HDL-C increase in the structured care group compared with usual care.2 This was in the setting of achieving an LDL-C level of 100 mg/dL (2.59 mmol/L) in 95% of patients in the structured care group (a 46% decrease in LDL-C from baseline values). After multiple regression analysis, the beneficial effect associated with HDL-C increase was independent of the LDL-C reduction (hazard ratio for each 4 mg/dL [0.10 mmol/L] increase in HDL-C, 0.85; 95% confidence interval, 0.76-0.94; P = .002).2
A relatively small increase in HDL-C (mean, 7%) observed during 3 years of statin treatment was associated with clinical event reduction, supporting the findings of Nicholls et al.1
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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