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To the Editor: Dr Nissen’s editorial¹ hypothesizes that the early benefits of statin therapy for patients with ACS is due to the anti-inflammatory effects of these drugs, whereas the delayed benefits are lipid-modulated. He bases this on the differences in high sensitivity C-reactive protein reduction in the MIRACL² and PROVE IT trials³ (34% and 38%, respectively) and the much smaller reduction in the A to Z trial⁴ (16.7%), which also had a lack of early outcome benefits in the group receiving 80 mg of simvastatin. However, there were important differences between the trials that may have affected the results. The A to Z trial population was older, the events were more acute, and the high sensitivity C-reactive protein levels were higher at baseline than in the PROVE IT trial. Also, the A to Z trial was conducted internationally (only 20% in the United States) while the PROVE IT trial was . . . [Full Text of this Article]

Michael H. Davidson, MD
michaeldavidson@radiantresearch.com
Rush University Medical Center
Radiant Research
Chicago, Ill

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