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To the Editor:
The editorial by Goldstein about brain hemorrhage asks whether we should worry about low cholesterol and the editorialist presents epidemiologic data that indeed we should.1 Further evidence comes from the J-LIT2 study where hypercholesterolemic patients without stroke from 6,500 general practitioners were placed on simvastatin for 6 years.
The cerebrovascular disease rate was found to be 1.7% in the highest octile for total cholesterol at baseline, >322 mg/dL (8.2 mM), which was the on-statin group of >280 mg/dL (7.2 mM). On the other hand, the rate was 6.3%, 3.7× higher, in the bottom octile, which was the group with baseline total cholesterol below 253 mg/dL (6.5 mM) and on-statin level of <160 mg/dL (4.1 mM). This begs the question why one would want to further lower cholesterol.
The editorialist dismisses the borderline significant doubled incidence of hemorrhagic stroke on simvastatin in the placebo-controlled HPS study.3 While the HPS finding was indeed a post hoc subgroup result, the editorialist arguably misrepresents the Stroke Prevention with Aggressive Reduction in Cholesterol (SPARCL)4 atorvastatin (Lipitor) stroke study where the 66% increase in …
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