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In their recent article, Miller et al¹ highlight the relatively low and unchanged use of lipid-lowering agents among patients with coronary artery disease (CAD) at academic medical centers between 1994 and 1997. The picture appears disappointing overall and for women in particular. However, the use of lipid-lowering therapy (LLT) in the real world might be even less frequent. In fact, it is our opinion that the treatment figures obtained might be overestimations. First, patients participating in controlled clinical trials are usually highly motivated and more compliant with treatment than the general population. Second, the study involved medical centers of excellence in the United States and Canada. Third, when the results of the Scandinavian Simvastatin Survival Study were published in November 1994, a letter was distributed to all Prospective Randomized Evaluation of the Vascular Effects of Norvasc Trial (PREVENT) investigators, thereby increasing the likelihood of physicians putting those recommendations into practice.

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