Intensive lipid‐lowering therapy in the 12 months after an acute coronary syndrome in Australia: an observational analysis

In reply: We thank Dimmitt and Martin for their observations about our article.1 We do not believe the benefit of high dose therapy to be in dispute. It is misleading to suggest that the failure to show a reduction of events with high intensity therapy within 3–6 months after institution of treatment in the cited Cochrane review2 equates to no effect overall. The true benefits of statins become most apparent more than 12 months after starting therapy, and this is true for the comparison between high and low doses. While we acknowledge that the trials comparing statin dose do not show a significant reduction in coronary heart disease mortality, a meta‐analysis of the trials of high intensity therapy does result in a 15% reduction in myocardial infarction, a 19% reduction in coronary revascularisation, and a 14% reduction in stroke at 12‐month follow‐up compared with conventional dosage.3 The 2018 United States guidelines for the management of blood cholesterol,4 which supersede those cited by Dimmitt and Martin,5 describe this benefit, and recommend initiation of high intensity statin therapy in patients following an acute coronary syndrome. Our study suggests an important advantage of early initiation is to maximise the likelihood that these patients remain on this therapy in the long term.