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.
Davidson MH. High-Dose Statins in Acute Coronary Syndromes. JAMA. 2005;293(1):36–39. doi:10.1001/jama.293.1.38-a
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