Response by Vallejo-Vaz et al to Letters Regarding Article, “Low-Density Lipoprotein Cholesterol Lowering for the Primary Prevention of Cardiovascular Disease Among Men With Primary Elevations of Low-Density Lipoprotein Cholesterol Levels of 190 mg/dL or Above: Analyses From the WOSCOPS (West of Scotland Coronary Prevention Study) 5-Year Randomized Trial and 20-Year Observational Follow-Up”
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We thank Löwe et al for their interest in our recent study1 and the opportunity to offer further clarifications. Although we acknowledge the interest of the question raised by Löwe et al, we think they miss the main rationale and research question of our analysis,1 namely, to provide the only randomized controlled trial evidence in primary prevention for lipid lowering among individuals with low-density lipoprotein-cholesterol (LDL-C) >190 mg/dL, a level consistent with inherited or genetic dyslipidemia (primary hypercholesterolemia). Current guidelines cite that statins are likely to be beneficial for such patients, but they also acknowledge that there is no direct randomized controlled trial evidence to support these recommendations. Given ethical concerns that would be posed by giving placebo to patients with LDL-C >190 mg/dL, the WOSCOPS data offer the only option to answer this question.1 The authors cite that the unanswered question is, “Will providing statins to people at low risk of atherosclerosis cardiovascular disease lower …