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To the Editor: The article by Dr de Lemos et al¹ reporting the results of phase Z of the A to Z trial and the accompanying editorial by Dr Nissen² provide important new information about event reduction by statins. Differences between conclusions of the Myocardial Ischemia Reduction with Aggressive Cholesterol Lowering (MIRACL)³ and the Pravastatin or Atorvastatin Evaluation and Infection Therapy (PROVE IT)⁴ trials may be due to differences in trial design.

In contrast to the PROVE IT trial and the A to Z trial, MIRACL compared statin treatment with placebo, rather than an active comparator or different dose of statin treatment, and MIRACL relied on soft end points. The PROVE IT trial and the A to Z trial differed in the acuteness of the intervention setting, the magnitude of the difference in low-density lipoprotein cholesterol (LDL-C) levels among patients in the 2 treatment groups, and the LDL-C levels in . . . [Full Text of this Article]

John R. Crouse III, MD
jrcrouse@wfubmc.edu
Department of Medicine
Wake Forest University School of Medicine
Winston-Salem, NC

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