This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased.
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 …
AAN Members
We have changed the login procedure to improve access between AAN.com and the Neurology journals. If you are experiencing issues, please log out of AAN.com and clear history and cookies. (For instructions by browser, please click the instruction pages below). After clearing, choose preferred Journal and select login for AAN Members. You will be redirected to a login page where you can log in with your AAN ID number and password. When you are returned to the Journal, your name should appear at the top right of the page.
AAN Non-Member Subscribers
Purchase access
Letters: Rapid online correspondence
REQUIREMENTS
You must ensure that your Disclosures have been updated within the previous six months. Please go to our Submission Site to add or update your Disclosure information.
Your co-authors must send a completed Publishing Agreement Form to Neurology Staff (not necessary for the lead/corresponding author as the form below will suffice) before you upload your comment.
If you are responding to a comment that was written about an article you originally authored:
You (and co-authors) do not need to fill out forms or check disclosures as author forms are still valid
and apply to letter.
Submission specifications:
- Submissions must be < 200 words with < 5 references. Reference 1 must be the article on which you are commenting.
- Submissions should not have more than 5 authors. (Exception: original author replies can include all original authors of the article)
- Submit only on articles published within 6 months of issue date.
- Do not be redundant. Read any comments already posted on the article prior to submission.
- Submitted comments are subject to editing and editor review prior to posting.
