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To the Editor: In their randomized controlled trial, Dr Nissen and colleagues¹ reported that a daily dose of 80 mg of atorvastatin was associated with a greater reduction in the volume of coronary atheromas than was a daily dose of 40 mg of pravastatin. The authors concluded that their results supported aggressive cholesterol-lowering therapy.

We have several concerns about their study. First, the authors measured change of atheroma volume rather than change of lumen area. The latter is more important, as it determines the amount of blood that can be delivered to the myocardium. Change of atheroma volume cannot be translated to clinical events because adaptive mechanisms try to maintain a normal lumen area during early atherogenesis.² Second, the authors used 2 different statins. Thus, it is possible that the difference in outcome may have been due to variance in pleiotropic effects of the drugs rather than to differences in . . . [Full Text of this Article]

Uffe Ravnskov, MD, PhD
ravnskov@tele2.se
Lund, Sweden

Morley C. Sutter, MD, PhD
Department of Pharmacology and Therapeutics
University of British Columbia
Vancouver

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