BMJ 1998;317:1252 ( 31 October )

Letters

Cholestanol and survival with simvastatin

    More data are needed
    Authors' reply

More data are needed

The first 150 words of the full text of this article appear below.

EDITOR---Miettinen and colleagues identify a subgroup of Finnish patients with high cholestanol ratios who gained no benefit from statin treatment.1 They suggest that such patients have a low rate of cholesterol synthesis but a high rate of cholesterol absorption and that drugs that block the synthesis of cholesterol therefore do not improve survival.

Surprisingly, they presented no data on the falls in serum cholesterol concentrations observed with simvastatin treatment within each cholestanol quarter. This information is essential to fully understand the link between high cholestanol ratio and the smaller reduction in relative risk with simvastatin. It would also be interesting to know whether the balance between cholesterol absorption and synthesis as measured by the cholestanol ratio accounts for a big part of the variability between patients in the response of serum cholesterol concentrations to simvastatin.

The authors do not comment on the relatively low (21%) relative risk reduction . . . [Full text of this article]
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Relevant Article

Baseline serum cholestanol as predictor of recurrent coronary events in subgroup of Scandinavian simvastatin survival study
Tatu A Miettinen, Helena Gylling, Timo Strandberg, and Seppo Sarna
BMJ 1998 316: 1127-1130. [Abstract] [Full Text] [PDF]

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