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August 1, 2001

Atorvastatin for Acute Coronary Syndromes—Reply

Author Affiliations

Stephen J.LurieMD, PhD, Senior EditorIndividualAuthorJody W.ZylkeMD, Contributing EditorIndividualAuthor

JAMA. 2001;286(5):532-535. doi:10.1001/jama.286.5.532

In Reply: The MIRACL trial investigators appear to be advising treatment of all patients after ACS with atorvastatin, 80 mg/d, for 16 weeks. Furthermore, they assert that any other use of lipid-lowering drugs in ACS is not "evidence-based." However, the findings in the MIRACL study are in no way extraordinary enough to justify a claim of unique efficacy.1 Statistical significance of the reduction in cardiovascular disease events was barely achieved and with excessive loss to follow-up of patients receiving atorvastatin, undermining the central result. The benefit was produced by the "softest" of the end points, unstable angina, and with no difference in total cardiovascular disease events. In addition, there was no acute beneficial effect during the first several weeks when cardiovascular disease event rates are highest.