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January 5, 2005

High-Dose Statins in Acute Coronary Syndromes

JAMA. 2005;293(1):36-39. doi:10.1001/jama.293.1.38-a

To the Editor: Dr Nissen’s editorial1 hypothesizes that the early benefits of statin therapy for patients with ACS is due to the anti-inflammatory effects of these drugs, whereas the delayed benefits are lipid-modulated. He bases this on the differences in high sensitivity C-reactive protein reduction in the MIRACL2 and PROVE IT trials3 (34% and 38%, respectively) and the much smaller reduction in the A to Z trial4 (16.7%), which also had a lack of early outcome benefits in the group receiving 80 mg of simvastatin. However, there were important differences between the trials that may have affected the results. The A to Z trial population was older, the events were more acute, and the high sensitivity C-reactive protein levels were higher at baseline than in the PROVE IT trial. Also, the A to Z trial was conducted internationally (only 20% in the United States) while the PROVE IT trial was conducted entirely in the United States. These differences in the study populations may have accounted for the outcome differences.