A potentially confusing clinical message was sent in the article by Goldberg et al.1 The study, which emphasized the need for reduction of LDL-C below 100 mg/dL, did not address the newer concept of lowering LDL-C below 70 mg/dL for optimal protection in high-risk patients. Accordingly, patients with coronary artery disease and diabetes mellitus should be treated for an LDL-C goal of 70 mg/dL or less. The concern, of course, is that clinicians will adhere to the less than 100-mg/dL LDL-C guideline instead of less than 70 mg/dL in the treatment of high-risk patients.
Regarding cholesterol treatment, the Pravastatin or Atorvastatin Evaluation and Infection Therapy [PROVE-IT] trial revealed that vascular events were reduced with aggressive lipid-lowering tactics (eg, atorvastatin at 80 mg/day vs pravastatin at 40 mg/day). The message conveyed was that lower is better in waging the war against LDL-C and coronary artery disease.
Additionally, the high-sensitivity C-reactive protein (hs-CRP) test has utility in the management of risk assessment as well as dosage adjustment of the statin. Attention should be directed to LDL-C and hs-CRP levels in the management of high-risk patients.
Frank M. Shanley, DO
Address correspondence to: Diane Binetti, 124 E Main St, Ste 106, Denville, NJ 07834. E-mail: dibinetti@optonline.net.
We appreciate the thoughtful responses to our article by Drs Federman and Shanley.
Duke University and Durham VA Medical Center
Author Disclosure: The author has no conflict of interest with any product discussed in this article.
Address correspondence to: Kenneth C. Goldberg, MD, Division of Ambulatory Care, Box 11C, Durham VA Medical Center, 508 Fulton St, Durham, NC 27705. E-mail: kenneth.goldberg@duke.edu.
Impact of Hospital-Physician Integration on Medicare Patient Mix
April 11th 2025This study found no evidence that hospital employment of physicians resulted in physicians treating sicker patients, undercutting claims that hospital-employed physicians serve a higher-acuity patient mix.
Read More
Organizational Factors Associated With Variation in Primary Care Providers in ACOs
April 8th 2025A higher percentage of accountable care organization (ACO) primary care providers was associated with physician leadership, upside financial risk, and financial compensation of physicians tied to performance measures.
Read More
A coverage with evidence development (CED) study demonstrated significant and clinically meaningful benefits in patients with migraine treated with remote electrical neuromodulation (REN). Health plans should support clinicians’ REN prescriptions by ensuring adequate coverage.
Read More