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To the Editor: In his editorial¹ on statins in the treatment of ACS, Dr Nissen likely overstates the benefit and understates the risks of more aggressive therapy. All of the studies quoted had high dropout rates (10.8% for 16 weeks in the MIRACL trial; 31.7% for 2 years in the PROVE IT trial; and 32.8% for 2 years in the A to Z trial).^2-4 The broad composite clinical end points that were used in the atorvastatin studies were driven primarily by softer end points such as hospitalizations for unstable angina. Hard end points such as death or fatal and nonfatal myocardial infarctions were not affected by the more aggressive statin therapy (although longer study durations may have shown such an effect). These findings contrast with less aggressive therapies in the Scandinavian Simvastatin Survival Study⁵ (4S) and in the Cholesterol and Recurrent Events (CARE) trial⁶ in which hard end points . . . [Full Text of this Article]

William L. Isley, MD
isley.william@mayo.edu
Mayo Clinic
Rochester, Minn

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