LETTER
Hypolipidemic Drugs in Coronary Artery Disease
George B. Bittar, MD
1 June 1997 | Volume 126 Issue 11 | Pages 916-917
TO THE EDITOR:
I read with interest the article by Pasternak and colleagues on behalf of the Harvard Atherosclerosis Reversibility Project (HARP) Study Group [1]. I was disappointed in the authors' discussion of the article by Stein and colleagues [2], which compared simvastatin with cholestyramine. Pasternak and coworkers stated that combination therapy with simvastatin and cholestyramine decreased total and LDL cholesterol levels by only 15% and 21%, respectively. In fact, these numbers were related to the reduction induced only by the cholestyramine resin; simvastatin alone in dosages of 20 mg/d and 40 mg/d reduced the total cholesterol level by 26% and 33%, respectively. The corresponding reductions in LDL cholesterol levels were 32% and 40%, respectively.
Furthermore, Stein and colleagues' study was a comparative, randomized, open-label, 12-week multicenter trial; it was not a study of the combination of cholestyramine and simvastatin, as stated by Pasternak and associates.
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Author and Article Information
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Nasser Smith Pinkerton Cardiology, Inc., Terre Haute, IN 47802
1. Pasternak CR, Brown LE, Stone PH, Silverman DI, Gibson MC, Sacks FM. Effects of combination therapy with lipid-reducing drugs in patients with coronary heart disease and "normal" cholesterol levels. A randomized, placebo-controlled trial. The Harvard Atherosclerosis Reversibility Project (HARP) Study Group. Ann Intern Med. 1996; 125:529-40.
2. Stein E, Kreisberg R, Miller V, Mantell G, Washington L, Shapiro DR. Effects of simvastatin and cholestyramine in familial and nonfamilial hypercholesterolemia. Multicenter Group I. Arch Intern Med. 1990; 150:341-5.
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