szmtag Balanced Contribution (23.09.2016)
DÄ internationalArchive38/2016Balanced Contribution

Correspondence

Balanced Contribution

Dtsch Arztebl Int 2016; 113: 643. DOI: 10.3238/arztebl.2016.0643a

Egidi, G

LNSLNS

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.

DOI: 10.3238/arztebl.2016.0643a

Dr. med. Günther Egidi

Bremen, guenther.egidi@posteo.de

Conflict of interest statement

The author declares that no conflict of interest exists.

1.
Ramsden EC, Zamora D, Majchzrag-Hong S, et al.: Reevaluation of the traditional diet-heart hypothesis: analysis of recovered data from Minnesota Coronary Experiment (1968–73). BMJ 2016; 353: 1246 CrossRef MEDLINE PubMed Central
2.
Cannon CP, Braunwald E, Mc Cabe CH, et al.: Intensive versus moderate lipid lowering with statins after acute coronary syndromes. NEJM 2004; 350: 1495–1504 CrossRef MEDLINE
3.
Pasceri V, Patti G, Nusca A, Pristipino C, Richichi G, di Sciascio G: Randomized trial of atorvastatin for reduction of myocardial damage during coronary intervention results from the ARMYDA (Atorvastatin for Reduction of Myocardial Damage during Angioplasty) study. Circulation 2004; 110: 674–8 CrossRef MEDLINE
4.
Parhofer KG: The treatment of disorders of lipid metabolism. Dtsch Arztebl Int 2016; 113: 261–8 VOLLTEXT
1.Ramsden EC, Zamora D, Majchzrag-Hong S, et al.: Reevaluation of the traditional diet-heart hypothesis: analysis of recovered data from Minnesota Coronary Experiment (1968–73). BMJ 2016; 353: 1246 CrossRef MEDLINE PubMed Central
2.Cannon CP, Braunwald E, Mc Cabe CH, et al.: Intensive versus moderate lipid lowering with statins after acute coronary syndromes. NEJM 2004; 350: 1495–1504 CrossRef MEDLINE
3.Pasceri V, Patti G, Nusca A, Pristipino C, Richichi G, di Sciascio G: Randomized trial of atorvastatin for reduction of myocardial damage during coronary intervention results from the ARMYDA (Atorvastatin for Reduction of Myocardial Damage during Angioplasty) study. Circulation 2004; 110: 674–8 CrossRef MEDLINE
4.Parhofer KG: The treatment of disorders of lipid metabolism. Dtsch Arztebl Int 2016; 113: 261–8 VOLLTEXT

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