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To the Editor: In the IDEAL study, Dr Pedersen and colleagues¹ did not consider that about 95% of the patients receiving either 20 mg/d of simvastatin or 80 mg/d of atorvastatin experienced adverse effects, almost half of which were classified as serious. The results of previous statin trials suggest that only 7% to 8% of participants (and often much fewer) derived significant benefits, mostly with respect to a reduction in risk of nonfatal events.^2-3 Since many myocardial infarctions and strokes are not associated with permanent disability or serious sequelae, the high incidence of adverse effects in this study should cause concern. We would appreciate more detailed information about the number and nature of these adverse reactions.

Financial Disclosures: None reported.

Uffe Ravnskov, MD, PhD
ravnskov@tele2.se
Magle Stora Kyrkogata 9
Lund, Sweden

Paul J. Rosch, MD
Department of Medicine
New York Medical College
Valhalla

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

1. Pedersen TR, Faergeman O, Kastelein JJP, et al, for the Incremental Decrease in End Points Through Aggressive Lipid Lowering (IDEAL) Study Group. High-dose atorvastatin vs usual-dose simvastatin for secondary prevention after myocardial infarction: the IDEAL study: a randomized controlled trial. JAMA. 2005;294:2437-2445. FREE FULL TEXT 2. Scandinavian Simvastatin Survival Group. Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S). Lancet. 1994;344:1383-1389. FULL TEXT | ISI | PUBMED 3. Sacks FM, Pfeffer MA, Moye LA, et al. The effect of pravastatin on coronary events after myocardial infarction in patients with average cholesterol levels: Cholesterol and Recurrent Events Trial investigators. N Engl J Med. 1996;335:1001-1009. FREE FULL TEXT

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2006;295:2476.

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