This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Contact me when this article is cited  Related Content  • Related articles  • Similar articles in JAMA  Topic Collections  • Lipids and Lipid Disorders  • Cardiovascular Disease/ Myocardial Infarction  • Alert me on articles by topic

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

To the Editor: Although 2 randomized controlled trials previously evaluated the effect of early initiation of aggressive statin therapy following an acute coronary syndrome (ACS) event,^1-2 the A to Z trial reported by Dr de Lemos and colleagues³ is the first randomized controlled trial to evaluate a strategy of early initiation of treatment with a statin compared with a delayed approach. The impact of any comparison of early with delayed initiation (intensive or not) in the carefully designed and controlled setting of a clinical trial is likely to be different in clinical practice. Several studies have shown that the practice of delayed initiation of lipid-lowering medications is not as effective as early initiation with regard to patient adherence to long-term therapy and the achievement of target national cholesterol guideline goals.^4-5 There is a high likelihood that individuals intended to have delayed initiation would actually never be treated with statins, exposing . . . [Full Text of this Article]

Bruce Ovbiagele, MD
ovibes@mednet.ucla.edu
Stroke Center and Department of Neurology
University of California
Los Angeles

RELATED ARTICLES

High-Dose Statins in Acute Coronary Syndromes
John R. Crouse, III
JAMA. 2005;293(1):36.
EXTRACT | FULL TEXT  

High-Dose Statins in Acute Coronary Syndromes
Yale B. Mitchel
JAMA. 2005;293(1):37.
EXTRACT | FULL TEXT  

High-Dose Statins in Acute Coronary Syndromes
William L. Isley
JAMA. 2005;293(1):37-38.
EXTRACT | FULL TEXT  

High-Dose Statins in Acute Coronary Syndromes
Michael H. Davidson
JAMA. 2005;293(1):38.
EXTRACT | FULL TEXT  

High-Dose Statins in Acute Coronary Syndromes—Reply
James A. de Lemos, Michael A. Blazing, Robert M. Califf, Stephen D. Wiviott, and Eugene Braunwald
JAMA. 2005;293(1):38-39.
EXTRACT | FULL TEXT  

High-Dose Statins in Acute Coronary Syndromes—Reply
Steven E. Nissen
JAMA. 2005;293(1):39.
EXTRACT | FULL TEXT  

Early Intensive vs a Delayed Conservative Simvastatin Strategy in Patients With Acute Coronary Syndromes: Phase Z of the A to Z Trial
James A. de Lemos, Michael A. Blazing, Stephen D. Wiviott, Eldrin F. Lewis, Keith A. A. Fox, Harvey D. White, Jean-Lucien Rouleau, Terje R. Pedersen, Laura H. Gardner, Robin Mukherjee, Karen E. Ramsey, Joanne Palmisano, David W. Bilheimer, Marc A. Pfeffer, Robert M. Califf, Eugene Braunwald, and for the A to Z Investigators
JAMA. 2004;292(11):1307-1316.
ABSTRACT | FULL TEXT