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To the Editor: Dr Pedersen and colleagues¹ conclude that while high-dose atorvastatin for secondary prevention of coronary artery disease following acute myocardial infarction produced no statistically significant decrease in all-cause or cardiovascular mortality compared with usual-dose simvastatin, the lack of a difference between the 2 groups in adverse events classified as serious implies that patients with established coronary artery disease may benefit from intensive lipid lowering without serious adverse events.

While neither the primary end point of the study (all-cause or cardiovascular mortality) nor the outcome of serious adverse events reached statistical significance, 3 outcomes that did reach significance were drug discontinuations due to diarrhea, abdominal pain, and myalgias. Although the authors acknowledge that because it was an open-label trial the drug discontinuations may have been related to patients' knowledge of which drug they were taking, the study nevertheless provides better evidence for patient intolerance of atorvastatin than it does . . . [Full Text of this Article]

William E. Cayley, Jr, MD, MDiv
bcayley@yahoo.com
Department of Family Medicine
University of Wisconsin
Eau Claire

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