In Reply: The MIRACL trial investigators appear
to be advising treatment of all patients after ACS with atorvastatin, 80 mg/d,
for 16 weeks. Furthermore, they assert that any other use of lipid-lowering
drugs in ACS is not "evidence-based." However, the findings in the MIRACL
study are in no way extraordinary enough to justify a claim of unique efficacy.1 Statistical significance of the reduction in cardiovascular
disease events was barely achieved and with excessive loss to follow-up of
patients receiving atorvastatin, undermining the central result. The benefit
was produced by the "softest" of the end points, unstable angina, and with
no difference in total cardiovascular disease events. In addition, there was
no acute beneficial effect during the first several weeks when cardiovascular
disease event rates are highest.
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