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To the Editor: In his Clinical Crossroads article, Dr Caplan¹ discussed a 70-year-old man with coronary, aortic, and peripheral arterial disease who had an episode of brain ischemia caused by severe preocclusive internal carotid disease. Caplan recommended treatment with a high dose of statin (atorvastatin, 80 mg daily). However, this is based on extrapolation from studies of younger patients and does not consider adverse effects.

A secondary analysis of the Treating to New Target (TNT) study compared the outcomes of 10 mg vs 80 mg of atorvastatin daily in patients aged 65 to 75 years with stable coronary heart disease.² Despite participant selection and an open-label run-in phase that excluded patients with concomitant medical conditions that might increase the risk of statin-related adverse effects, this study found that with the higher dose of statin the absolute reduction of major fatal or nonfatal cardiovascular events (2.3%) was lower than the increase . . . [Full Text of this Article]

Luca Mascitelli, MD
lumasci@libero.it
Medical Service
Comando Brigata Alpina "Julia"
Udine, Italy

Francesca Pezzetta, MD
Cardiology Service
Ospedale di Tolmezzo
Tolmezzo, Italy

Mark R. Goldstein, MD
Fountain Medical Court
Bonita Springs, Florida

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