REPLY
Hypertriglyceridemia and Atherosclerosis
Henry N. Ginsberg, MD
1 January 1998 | Volume 128 Issue 1 | Page 74
IN RESPONSE:
Despite my attempts to portray the complexity the issue and, therefore, make physicians aware that treatment was not based on data as good as those for LDL Cholesterol, Dr. Avins obviously feels that my editorial was misdirected. In response to the major points of the letter: First, I omitted a very important recent paper from Hokanson and Austin [1] from my editorial. This meta-analysis convincingly demonstrated that triglyceride levels are independent predictors of future coronary artery disease in both men and women [1] and is more recent than either the 1989 or 1995 reports Dr. Avins coauthored.
Second, the central goal of my editorial was to provide physicians with insight into the complex metabolic abnormalities in lipoprotein that are associated with hypertriglyceridemia. The interaction data I mentioned support the view that hypertriglyceridemia is part of a potent atherogenic dyslipidemic state. Finally, although Dr. Avins states that niacin, statins, and gemfibrozil "are associated with serious side effects, great expense, or elevated risk for conditions other than coronary heart disease," niacin is one of the least expensive medications available for the treatment of any disease and has been shown to reduce events and mortality [2]. In addition, the statins have been shown to be safe and to markedly reduce events and mortality [3, 4]. It is inappropriate and misleading to lump all of these drugs together in any blanket statement. Overall, I believe that my conclusions are based on both sound epidemiologic data and the availability of appropriate and efficacious therapies.
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Author and Article Information
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College of Physicians & Surgeons of Columbia University; New York, NY 10032
1. Hokanson JE, Austin MA. Plasma triglyceride level is a risk factor for cardiovascular disease independent of high-density lipoprotein cholesterol: a meta-analysis of population-based prospective studies. J Cardiovasc Risk. 1996; 3:213-9.
2. Canner PL, Berge KG, Wenger NK, Stamler J, Friedman L, Prineas RJ, et al. Fifteen year mortality in Coronary Drug Project patients: long-term benefit with niacin. J Am Coll Cardiol. 1986; 8:1245-55.
3. Shepherd J, Cobbe SM, Ford I, Isles CG, Lorimer AR, MacFarlane PW, et al. Prevention of coronary heart diseases with prvastatin in men with hypercholesterolemia. West of Scotland Coronary Prevention Study Group. N Engl J Med. 1995; 333:1301-7.
4. Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S). Lancet. 1994; 344:1383-9.
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