Response to Letter Regarding Article, "Hyperlipidemia in Early Adulthood Increases Long-Term Risk of Coronary Heart Disease".

We thank Dr Hayward for his interest in our article.1 First, we note that our study was not intended to negate a risk-based approach to statin therapy. In fact, some of us have pioneered and led multiple efforts in the development of risk prediction algorithms.2 Our finding that cumulative exposure to elevated non–high-density lipoprotein cholesterol increases coronary heart disease risk highlights that both cardiovascular disease risk and cardiovascular disease risk factor exposures should be considered over >10-year windows. In other words, duration of exposure to a risk factor, in this case hyperlipidemia, is important and should be used in part to identify those who may benefit from statin therapy and those who may be identified by current risk-based algorithms. Dr Hayward notes that our …