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Nov 12, 2011


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The argument that the HERS results did not apply to primary prevention reminds me of one of the arguments that is made about the ENHANCE trial. ENHANCE was a trial of 80 mg simvastatin/10 mg. ezetimibe vs. 80 simva/placebo in patients with heterozygous familial hypercholesterolemia. In fact, not only did the patients have FH, but their average LDL levels were in the 300s. One would have expected that an LDL-lowering drug would be most beneficial in patients with a very high LDL, especially in light of the fact that their LDL on 80 mg simva was still quite high. Yet when the trial was negative, an argument was made that because this was a special population with very high LDL, the results could not be generalized to non-FH patients with more moderate LDL levels.

With respect to HRT and WHI, can you comment on the so-called "timing hypothesis"? The argument as I understand it is that WHI was a flawed trial in part because many of the patients were a decade or more past menopause, and that HRT initiated at the time of menopause could still be beneficial for prevention of coronary disease and other things. There is also the argument that WHI used the wrong type of HRT. I am skeptical of these arguments.

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