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Comment and Response |

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

Jonas B. Green, MD, MPH, MSHS1; Joseph S. Ross, MD, MHS2,3; Harlan M. Krumholz, MD, SM3,4,5,6; Good Stewardship Working Group of the National Physicians Alliance
[+] Author Affiliations
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, Connecticut
3Center for Outcomes Research and Evaluation, Yale–New Haven Hospital, New Haven, Connecticut
4Section of Health Policy and Administration, Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, Connecticut
5Robert Wood Johnson Foundation Clinical Scholars Program, Yale University School of Medicine, New Haven, Connecticut
6Section 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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In Reply Dr Borzak misunderstands our point about choosing a generic statin for cardiovascular risk reduction. Even if the benefits of statins are related entirely to lipid lowering—a point of controversy for some people—we cannot infer that every drug that lowers low density lipoprotein cholesterol (LDL-C) level will reduce risk. Drugs have many effects, and the influence on LDL-C may not convey whether patients will ultimately benefit. There are many examples when treatment of patients with drugs that lowered LDL-C level was not associated with better outcomes. For this reason, the clinical trial information is critically important and, at this point, we cannot say whether ezetimibe is a drug that improves patient outcomes. Statins are the only drugs with strong clinical trial evidence demonstrating improved patient outcomes.

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August 12, 2013
Steven Borzak, MD
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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