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The question that I'm really curious about your opinion on, though, is whether, in general, lipid-lowering by serial lipid measurements is a valid surrogate end-point in studies. My opinion is since we've shown that in some instances, such as niacin and ezetimibe treatments, that lipid-lowering does NOT correlate with clinically relevant end-points, we should quit using them as surrogate end-points. If one is to demonstrate that an intervention is effective, regardless of whether the intervention is dietary, lifestyle changes, supplements, herbal medications or prescription medications, it needs to be shown to alter a clinically relevant outcome.

I think that lipid-lowering with specific endpoints is valid in terms of helping to understand an effect of a drug or other intervention. But for assessing real-life clinical benefit, that's a meaningful endpoint only if it's totally clear that manipulating that given value carries real clinical benefit and is not cancelled out by negative corollary consequences.

I think that there is still a lot to learn about the intricacies of our lipids and the interactions and contexts that shape their impact on our health and longevity.

=sheila
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