Lovastatin vs Cholestyramine Therapy for Primary Hypercholesterolemia-Reply

In Reply. — In response to Dr Goldstein, our study was a comparison of the tolerability and lipid-lowering effects of lovastatin and cholestyramine, so that our conclusion that lovastatin is more effective than cholestyramine applies only to the effects of the two drugs on lipids and lipoproteins, in particular the primary variables total and low-density lipoprotein (LDL) cholesterol. On this basis, 40 mg of lovastatin twice a day was approximately twice as effective as 12 g of cholestyramine twice a day, producing mean reductions in total and LDL-cholesterol of 34% and 42%, respectively, compared with 17% and 23% for cholestyramine. We agree that the ultimate value of lipid-lowering agents should be based on their effects on artherosclerosis. Several clinical trials to examine the effects of lovastatin and the closely related simvastatin on coronary lesion progression and coronary event rates are under way or about to begin. Although the results of