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January 5, 2005

High-Dose Statins in Acute Coronary Syndromes

JAMA. 2005;293(1):36-39. doi:10.1001/jama.293.1.36-b

To the Editor: Although 2 randomized controlled trials previously evaluated the effect of early initiation of aggressive statin therapy following an acute coronary syndrome (ACS) event,1,2 the A to Z trial reported by Dr de Lemos and colleagues3 is the first randomized controlled trial to evaluate a strategy of early initiation of treatment with a statin compared with a delayed approach. The impact of any comparison of early with delayed initiation (intensive or not) in the carefully designed and controlled setting of a clinical trial is likely to be different in clinical practice. Several studies have shown that the practice of delayed initiation of lipid-lowering medications is not as effective as early initiation with regard to patient adherence to long-term therapy and the achievement of target national cholesterol guideline goals.4,5 There is a high likelihood that individuals intended to have delayed initiation would actually never be treated with statins, exposing them to unnecessary cardiovascular risk.

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