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To the Editor: Although 2 randomized controlled trials previously evaluated the effect of early initiation of aggressive statin therapy following an acute coronary syndrome (ACS) event,^1-2 the A to Z trial reported by Dr de Lemos and colleagues³ is the first randomized controlled trial to evaluate a strategy of early initiation of treatment with a statin compared with a delayed approach. The impact of any comparison of early with delayed initiation (intensive or not) in the carefully designed and controlled setting of a clinical trial is likely to be different in clinical practice. Several studies have shown that the practice of delayed initiation of lipid-lowering medications is not as effective as early initiation with regard to patient adherence to long-term therapy and the achievement of target national cholesterol guideline goals.^4-5 There is a high likelihood that individuals intended to have delayed initiation would actually never be treated with statins, exposing . . . [Full Text of this Article]

Bruce Ovbiagele, MD
ovibes@mednet.ucla.edu
Stroke Center and Department of Neurology
University of California
Los Angeles

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