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To the Editor: In the IDEAL study, Dr Pedersen and colleagues¹ conclude that intensive cholesterol reduction in patients with prior myocardial infarction can provide benefit without increasing serious adverse effects. However, the incidence of adverse events necessitating permanent discontinuation of high-dose atorvastatin treatment (9.6%) was more than twice that of withdrawal from standard-dose simvastatin (4.2%). In the TNT study, there was also an increase in treatment-related adverse events in patients taking atorvastatin, 80 mg/d, compared with the 10-mg/d regimen (8.1% vs 5.8%; P<.001).² In that study, the number needed to harm of 43 to produce 1 treatment-induced adverse event was similar to the number needed to treat of 45 to produce a reduction in the first cardiovascular event. In the A to Z trial, there was a significantly higher incidence of myopathy with high-dose simvastatin compared with standard therapy.³ Similarly, the incidence of alanine aminotransferase elevation to higher than . . . [Full Text of this Article]

Hean T. Ong, MBBS, FRCP
htyl@streamyx.com
H. T. Ong Heart Clinic
Georgetown, Penang, Malaysia

Jim Seng Cheah, MBBS, FRACP, FRCP
National University of Singapore
Kent Ridge

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