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To the Editor: In his Editorial discussing recent trials of statins, Dr Cannon¹ did not address some of the remaining questions. First, the 4 contemporaneous trials discussed (PROVE IT-TIMI 22,² A to Z,³ TNT,⁴ and, now, the IDEAL trial⁵) have failed to show a reduction in all-cause mortality despite the use of aggressive and higher doses. Second, while previous concerns about increased incidence of cancer and other noncardiac deaths have been somewhat allayed in careful post hoc analysis in these studies, the number of participants who developed cancer in each of these trials may have been too small to find significant differences.

In addition, with the A to Z and IDEAL trials showing no difference in primary outcomes, attributes that may vary among statins, such as pleiotropic or anti-inflammatory effects, may be more pertinent in patients with acute coronary syndrome. Finally, there is a lack of prospective data in . . . [Full Text of this Article]

Rohit Arora, MD
rohit.arora@med.va.gov

Saravanan Balamuthusamy, MD, MPH
Department of Medicine
Chicago Medical School at Rosalind Franklin University
North Chicago, Ill

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