The doubtful association between blood lipid changes and progression of coronary calcification

We greatly appreciated the interesting and stimulating discussion letter by Ravnskov [ [1] Ravnskov U. The doubtful association between blood lipid changes and progression of atherosclerosis. Int J Cardiol, 2011 Sep 19. [Epub ahead of print]. Google Scholar ] commenting on our recent study which concluded that both cholesterol changes over time and presence of lipid lowering therapy do not seem to have any measurable effect on the rate of progression of coronary calcification when assessed by computerized tomography (CT) [ [2] Tenenbaum A. Shemesh J. Koren-Morag N. et al. Long-term changes in serum cholesterol level does not influence the progression of coronary calcification. Int J Cardiol. 2011; 150: 130-134 Abstract Full Text Full Text PDF PubMed Scopus (12) Google Scholar ]. We believe that the process of calcification may spread out in a different manner than the overall development of atherosclerosis. It is interesting to point out a total failure of statins and/or ezetimibe based lipid lowering therapy to stop the progression of calcific aortic stenosis [ 3 Cowell S.J. Newby D.E. Prescott R.J. et al. Scottish Aortic Stenosis and Lipid Lowering Trial, Impact on Regression (SALTIRE) investigators. A randomized trial of intensive lipid-lowering therapy in calcific aortic stenosis. N Engl J Med. 2005; 352: 2389-2397 Crossref PubMed Scopus (858) Google Scholar , 4 Chan K.L. Teo K. Dumesnil J.G. Ni A. Tam J. ASTRONOMER investigators. Effect of lipid lowering with rosuvastatin on progression of aortic stenosis: results of the aortic stenosis progression observation: measuring effects of rosuvastatin (ASTRONOMER) trial. Circulation. 2010; 121: 306-314 Crossref PubMed Scopus (557) Google Scholar , 5 Rossebø A.B. Pedersen T.R. Boman K. et al. SEAS investigatorsIntensive lipid lowering with simvastatin and ezetimibe in aortic stenosis. N Engl J Med. 2008; 359: 1343-1356 Crossref PubMed Scopus (1274) Google Scholar ] despite their clear clinical benefits in reducing atherosclerotic vascular events.