Fixed-dose Strategy Is Lacking
Parhofer deserves thanks for his excellent summary of the current state of research into treating lipid metabolism disorders (1). However, as a primary care physician I wish to challenge him on two issues.
- Parhofer writes himself that in the IMPROVE-IT Study, ezetimibe did not lower cardiovascular nor all-cause mortality, in spite of a very large number of participants and a number needed to treat (NNT) of 350/year. Four pages later, however, he recommends exactly this treatment.
- The readership aimed at with this review article consists of primary care physicians too. It is therefore surprising that Parhofer addresses merely the target value strategy, as recommended by the German Society of Cardiology and the German Society of Internal Medicine, but not the equally well-founded strategy of the fixed dose, as discussed by the German College of General Practitioners and Family Physicians (DEGAM) in the national clinical practice guideline on chronic coronary heart disease (3) or the US ACC/AHA guidelines of 2013 (4).
Dr. med. Thomas Maibaum
Conflict of interest statement
Dr Maibaum has received author fees from Deutscher Ärzteverlag.
|1.||Parhofer KG: The treatment of disorders of lipid metabolism. Dtsch Arztebl Int 2016; 113: 261–8 VOLLTEXT|
|2.||Nationale Versorgungsleitlinie KHK (long version; 4th edition, version 1). www.leitlinien.de/mdb/downloads/nvl/khk/khk-4aufl-vers1-lang.pdf (last accessed on 19 July 2016).|
|3.||Stone NJ, Robinson JG, Lichtenstein AH, et al.: 2013 ACC/AHA-guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults. Circulation 2014; 129: 1–45. CrossRef CrossRef MEDLINE|