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January 5, 2005

High-Dose Statins in Acute Coronary Syndromes—Reply

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

In Reply: We agree with Dr Crouse that differences in study design and in the LDL-C levels between patients receiving treatment and those not receiving treatment in the A to Z trial and the PROVE IT trial may have contributed to differences in outcomes between the 2 studies. Because cholesterol-lowering studies typically enroll patients with variable cholesterol levels at entry and then treat patients with fixed dosages of study drug, they are not well-suited to identify specific LDL-C level treatment goals. On the other hand, the A to Z trial and the PROVE IT trial do suggest that more aggressive LDL-C level lowering strategies reduce intermediate (2-year) adverse event rates in patients with ACS and support, albeit indirectly, an LDL-C level treatment goal substantially below 100 mg/dL (<2.59 mmol/L). Further studies are needed before a specific LDL-C treatment goal of 70 mg/dL (1.81 mmol/L) can be firmly established. Finally, no patients in the A to Z trial met the stringent definition of rhabdomyolysis from the American College of Cardiology, the American Heart Association, and the National Heart, Lung, and Blood Institute, which requires concomitant renal failure in addition to muscle symptoms and creatine phosphokinase elevation.

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