Professor Parhofer takes a balanced approach in his article on disorders of lipid metabolism. He mentions that no consensus exists internationally on whether defined target LDL concentrations should be attained or whether medications other than statins should be used. And he writes that the benefit of LDL targets has never been confirmed. How relevant is a finding of plaque regression on intravascular ultrasonography? It is possible that communicating the LDL concentration to the patient may improve adherence to statin treatment. However, we think it is better to decide in partnership with the patient what their treatment should be—by using ARRIBA (www.arriba-hausarzt.de), for example. Is the classification into different lipid disorders really clinically relevant? Are nutritional/dietary recommendations actually still sustainable? What benefit does therapy using high doses of statins really confer in acute coronary syndrome? One of the cited studies showed a benefit for high doses with regard to inpatient admission and revascularization, but none for (re-)infarction rates and all-cause mortality. The other study compared atorvastatin not with low-dosage statins but with placebo—this is not proof of any benefit of high doses. The recommendation of the Drug Commission of the German Medical Association (Arzneimittelkommission der Ärzteschaft) and of US specialist societies—that of not controlling lipids when the indication for statin treatment is given—remains unrefuted.
Dr. med. Günther Egidi
Conflict of interest statement
The author declares that no conflict of interest exists.
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