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February 3, 1999

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

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

In Reply: Clinical trials of cholesterol-lowering therapy with inhibitors of HMG-CoA reductase inhibitors or statins demonstrate an early time to benefit that extends across the spectrum of absolute risk in patients with CHD13 (Table 1). In a reiteration of data from the 4S trial, Drs Kandzari and Goldschmidt-Clermont illustrate differences in mortality according to time of the acute coronary event.1 Although tests of statistical significance are not provided, the authors suggest that simvastatin has properties of "an efficient antiarrhythmic agent." They cite unrelated studies on the regulatory role of polyunsaturated fatty acids on Na+-Ca2+ exchange and adenosine triphosphate–inhibited channels potassium and speculate that simvastatin has membrane-stabilizing properties via this mechanism. To our knowledge, there is no evidence to support this hypothesis.

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