Management of Dyslipidemia for Cardiovascular Disease Risk Reduction
Authors: Jonathan A. Tobert, Connie B. Newman
Journal: Annals of Internal Medicine (2016)

Letters5 April 2016Management of Dyslipidemia for Cardiovascular Disease Risk ReductionJonathan A. Tobert, MD, PhD and Connie B. Newman, MDJonathan A. Tobert, MD, PhDFrom University of Oxford, Oxford, United Kingdom, and New York University School of Medicine, New York, New York. and Connie B. Newman, MDFrom University of Oxford, Oxford, United Kingdom, and New York University School of Medicine, New York, New York.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/L15-0523 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:In their clinical guideline on the management of dyslipidemia, Downs and O'Malley state, "Muscle-related symptoms were the most frequent adverse effects of statins seen in trials in 10% to 20% of patients" (1). Three of the 4 references cited are observational studies, not trials. These studies can measure the frequency of adverse events reported during treatment but are at risk for confounding. Furthermore, compared with randomized, double-blind, placebo-controlled clinical trials, observational studies are generally less reliable for assessing causality. Without causality, an event is not an effect. The fourth reference that they cite is a meta-analysis that ...References1. Downs JR, O'Malley PG. Management of dyslipidemia for cardiovascular disease risk reduction: synopsis of the 2014 U.S. Department of Veterans Affairs and U.S. Department of Defense clinical practice guideline. Ann Intern Med. 2015;163:291-7. [PMID: 26099117]. doi:10.7326/M15-0840 LinkGoogle Scholar2. Naci H, Brugts J, Ades T. Comparative tolerability and harms of individual statins: a study-level network meta-analysis of 246 955 participants from 135 randomized, controlled trials. Circ Cardiovasc Qual Outcomes. 2013;6:390-9. [PMID: 23838105] doi:10.1161/CIRCOUTCOMES.111.000071 CrossrefMedlineGoogle Scholar3. Heart Protection Study Collaborative Group. MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20,536 high-risk individuals: a randomised placebo-controlled trial. Lancet. 2002;360:7-22. [PMID: 12114036] CrossrefMedlineGoogle Scholar4. Newman CB, Tobert JA. Statin intolerance: reconciling clinical trials and clinical experience. JAMA. 2015;313:1011-2. [PMID: 25756433] doi:10.1001/jama.2015.1335 CrossrefMedlineGoogle Scholar5. Kashani A, Phillips CO, Foody JM, et al. Risks associated with statin therapy: a systematic overview of randomized clinical trials. Circulation. 2006;114:2788-97. [PMID: 17159064] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From University of Oxford, Oxford, United Kingdom, and New York University School of Medicine, New York, New York.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=L15-0523. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoManagement of Dyslipidemia for Cardiovascular Disease Risk Reduction: Synopsis of the 2014 U.S. Department of Veterans Affairs and U.S. Department of Defense Clinical Practice Guideline John R. Downs and Patrick G. O'Malley Management of Dyslipidemia for Cardiovascular Disease Risk Reduction John R. Downs and Patrick G. O'Malley Metrics Cited byAssociation between the nickel exposure and lipid profiles in general population from NHANESAnalysis of Coronary Artery Lesion Degree and Related Risk Factors in Patients with Coronary Heart Disease Based on Computer-Aided Diagnosis of Coronary AngiographyNight sleep duration and risk of each lipid profile abnormality in a Chinese population: a prospective cohort studyAssociation of circulating selenium concentration with dyslipidemia: Results from the NHANESPCSK9 positively correlates with plasma sdLDL in community-dwelling population but not in diabetic participants after confounder adjustmentDietary Patterns in Relation to Components of Dyslipidemia and Fasting Plasma Glucose in Adults with Dyslipidemia and Elevated Fasting Plasma Glucose in TaiwanNovel and traditional lipid-related biomarkers and their combinations in predicting coronary severity 5 April 2016Volume 164, Issue 7Page: 509KeywordsClinical trial reportingClinical trialsDisclosureDyslipidemiaMusclesObservational studiesOdds ratioRhabdomyolysisRisk managementStatins ePublished: 5 April 2016 Issue Published: 5 April 2016 Copyright & PermissionsCopyright © 2016 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...