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Comment and Response |

The Case for Generic Statins: Not If They Don’t Work So Well

Steven Borzak, MD1
[+] Author Affiliations
1Department of Medicine, University of Miami Miller School of Medicine, Atlantis, Florida
JAMA Intern Med. 2013;173(15):1473-1474. doi:10.1001/jamainternmed.2013.7798.
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To the Editor Green et al1(p229) make a case for generic statins as “the appropriate choice for dyslipidemic patients” but fail to consider the evidence as applied to high-risk subjects. While the authors correctly note that there is a very limited data set comparing one statin drug to another, their conclusion—that the data therefore support choosing the less-expensive drug—fails to consider the predominant mechanism of action: lowering low-density lipoprotein cholesterol (LDL-C) level. Considering the totality of trials evidence, the best meta-analysis shows that the clinical benefit of reducing hard end points in statin trials is most closely related to and best predicted by the decrease in LDL-C level from baseline.2 Consequently, in high-risk patients, the data support and guidelines call for a greater degree of LDL-C lowering,3 which can only be achieved through the use of atorvastatin, rosuvastatin, or high-dose simvastatin (which is no longer recommended by the Food and Drug Administration) and not by whatever generic statin is available.

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Correspondence

August 12, 2013
Jonas B. Green, MD, MPH, MSHS; Joseph S. Ross, MD, MHS; Harlan M. Krumholz, MD, SM; Good Stewardship Working Group of the National Physicians Alliance
1Cedars-Sinai Medicine, Department of Medicine, Cedars-Sinai Health System, Los Angeles, California
2Section of General Internal Medicine, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut3Center for Outcomes Research and Evaluation, Yale–New Haven Hospital, New Haven, Connecticut
3Center for Outcomes Research and Evaluation, Yale–New Haven Hospital, New Haven, Connecticut4Section of Health Policy and Administration, Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, Connecticut5Robert Wood Johnson Foundation Clinical Scholars Program, Yale University School of Medicine, New Haven, Connecticut6Section of Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
JAMA Intern Med. 2013;173(15):1474. doi:10.1001/jamainternmed.2013.7781.
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