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February 3, 1999

Coronary Events With Lipid-Lowering Therapy: The AFCAPS/TexCAPS Trial

Author Affiliations

Margaret A.WinkerMD, Deputy EditorIndividualAuthorPhil B.FontanarosaMD, Interim Co-EditorIndividualAuthor

JAMA. 1999;281(5):414-419. doi:10-1001/pubs.JAMA-ISSN-0098-7484-281-5-jbk0203

To the Editor: Drs Rosenson and Tangney1 addressed the unique abilities of 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors to modify endothelial function, stabilize coronary plaques, and reduce vascular inflammation and thrombus formation. The authors suggest that these features may be largely responsible for the marked reductions in cardiovascular events demonstrated in recent primary and secondary prevention trials. We propose a further mechanism of HMG-CoA reductase inhibitors that may contribute to reduction in sudden cardiac death. In the Scandinavian Simvastatin Survival Study (4S), simvastatin was shown to prevent more specifically unwitnessed deaths and deaths within 1 hour of the inciting event.2 In contrast, less effect was observed toward death after 1 hour and more than 24 hours (Figure 1). Such effects on "rapid death" would be expected from treatment with an efficient antiarrhythmic agent.

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