Treatment of Blood Cholesterol to Reduce Risk for Atherosclerotic Cardiovascular Disease
Authors: William C. Taylor
Journal: Annals of Internal Medicine (2016)

Letters19 January 2016Treatment of Blood Cholesterol to Reduce Risk for Atherosclerotic Cardiovascular DiseaseWilliam C. Taylor, MDWilliam C. Taylor, MDFrom Beth Israel Deaconess Medical Center, Boston, Massachusetts.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/L15-0521 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE:I am honored to reply to authors of the guideline (1). Dr. Lloyd-Jones and colleagues correctly point out that I cited authors who believe that the risk estimator recommended in the guideline overestimates risk, but their focus on the accuracy of this estimator misses the point. Because I assumed that this risk estimator was correct in my calculations, resolving the controversy about its accuracy will not resolve the problems with the guideline that I noted.Dr. Lloyd-Jones and colleagues' comment that hypertension and diabetes are treated for more than 1 year suggests a fundamental misunderstanding. Those of us ...References1. Stone NJ, Robinson JG, Lichtenstein AH, Bairey Merz CN, Blum CB, Eckel RH, et al; American College of Cardiology/American Heart Association Task Force on Practice Guidelines. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014;63:2889-934. [PMID: 24239923] doi:10.1016/j.jacc.2013.11.002 CrossrefMedlineGoogle Scholar2. Graham R, Mancher M, Wolman DM, Greenfield S, Steinberg E; Committee on Standards for Developing Trustworthy Clinical Practice Guidelines. Clinical Practice Guidelines We Can Trust. Washington, DC: National Academies Pr; 2011. Google Scholar3. Downs JR, Clearfield M, Weis S, Whitney E, Shapiro DR, Beere PA, et al. Primary prevention of acute coronary events with lovastatin in men and women with average cholesterol levels: results of AFCAPS/TexCAPS Air Force/Texas Coronary Atherosclerosis Prevention Study. JAMA. 1998;279:1615-22. [PMID: 9613910] CrossrefMedlineGoogle Scholar4. Nakamura H, Arakawa K, Itakura H, Kitabatake A, Goto Y, Toyota T, et al; MEGA Study Group. Primary prevention of cardiovascular disease with pravastatin in Japan (MEGA Study): a prospective randomised controlled trial. Lancet. 2006;368:1155-63. [PMID: 17011942] CrossrefMedlineGoogle Scholar5. ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial Major outcomes in moderately hypercholesterolemic, hypertensive patients randomized to pravastatin vs usual care: the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT-LLT). JAMA. 2002;288:2998-3007. [PMID: 12479764] MedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Beth Israel Deaconess Medical Center, Boston, Massachusetts.Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterest Forms.do?msNum=M15-1125. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoTreatment of Blood Cholesterol to Reduce Risk for Atherosclerotic Cardiovascular Disease Murray A. Mittleman , William C. Taylor , Gerald Smetana , and Risa B. Burns Treatment of Blood Cholesterol to Reduce Risk for Atherosclerotic Cardiovascular Disease Donald M. Lloyd-Jones , David C. Goff , and Neil J. Stone Metrics Cited byCardiovascular Prevention: Migrating From a Binary to a Ternary Classification 19 January 2016Volume 164, Issue 2Page: 135KeywordsBloodCholesterolConflicts of interestDecision makingDisclosureExtrapolationHypertensionMedical conditionsPatientsStatins ePublished: 19 January 2016 Issue Published: 19 January 2016 Copyright & PermissionsCopyright © 2016 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...