This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Contact me when this article is cited  Related Content  • Related articles  • Similar articles in JAMA  Topic Collections  • Lipids and Lipid Disorders  • Cardiovascular Disease/ Myocardial Infarction  • Alert me on articles by topic

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

In Reply: Dr Port challenges our conclusion that the regression observed in the ASTEROID trial was related to changes in LDL-C and HDL-C levels. We strongly disagree. Atherosclerosis imaging studies using coronary angiography, carotid ultrasound, and intravascular ultrasound have been performed for nearly 2 decades.^1-3 Benefits have consistently been proportional to the extent of reduction of LDL-C or the increase of HDL-C. These benefits have been observed for several different classes of therapeutic agents, including bile acid resins, nicotinic acid, and statins. While it is true that many researchers (including us⁴) have reported "pleiotropic" effects of statins, there is no scientific basis to suggest that these effects are the dominant factor in determining disease progression rates. We think the overwhelming body of evidence supports the conclusion that LDL-C is the most important determinant of progression rate.

We also disagree with Port regarding interpretation of the subgroup analyses in Table . . . [Full Text of this Article]

Steven E. Nissen, MD
nissens@ccf.org
Cleveland Clinic Foundation
Cleveland, Ohio

RELATED ARTICLES

High-Dose Statins and Atherosclerosis Regression
Sid C. Port
JAMA. 2006;296(15):1836.
EXTRACT | FULL TEXT  

High-Dose Statins and Atherosclerosis Regression
Yoseph Rozenman
JAMA. 2006;296(15):1836.
EXTRACT | FULL TEXT  

High-Dose Statins and Atherosclerosis Regression
Clemens von Birgelen and Marc Hartmann
JAMA. 2006;296(15):1837.
EXTRACT | FULL TEXT  

Effect of Very High-Intensity Statin Therapy on Regression of Coronary Atherosclerosis: The ASTEROID Trial
Steven E. Nissen, Stephen J. Nicholls, Ilke Sipahi, Peter Libby, Joel S. Raichlen, Christie M. Ballantyne, Jean Davignon, Raimund Erbel, Jean Charles Fruchart, Jean-Claude Tardif, Paul Schoenhagen, Tim Crowe, Valerie Cain, Kathy Wolski, Marlene Goormastic, E. Murat Tuzcu, and for the ASTEROID Investigators
JAMA. 2006;295(13):1556-1565.
ABSTRACT | FULL TEXT  

High-Dose Statins in Acute Coronary Syndromes: Not Just Lipid Levels
Steven E. Nissen
JAMA. 2004;292(11):1365-1367.
EXTRACT | FULL TEXT