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In Reply: We agree with Dr Crouse that differences in study design and in the LDL-C levels between patients receiving treatment and those not receiving treatment in the A to Z trial and the PROVE IT trial may have contributed to differences in outcomes between the 2 studies. Because cholesterol-lowering studies typically enroll patients with variable cholesterol levels at entry and then treat patients with fixed dosages of study drug, they are not well-suited to identify specific LDL-C level treatment goals. On the other hand, the A to Z trial and the PROVE IT trial do suggest that more aggressive LDL-C level lowering strategies reduce intermediate (2-year) adverse event rates in patients with ACS and support, albeit indirectly, an LDL-C level treatment goal substantially below 100 mg/dL (<2.59 mmol/L). Further studies are needed before a specific LDL-C treatment goal of 70 mg/dL (1.81 mmol/L) can be firmly established. Finally, no . . . [Full Text of this Article]

James A. de Lemos, MD
james.delemos@utsouthwestern.edu
University of Texas Southwestern Medical Center
Dallas

Michael A. Blazing, MD; Robert M. Califf, MD
Duke Clinical Research Institute
Durham, NC

Stephen D. Wiviott, MD; Eugene Braunwald, MD
Brigham and Women’s Hospital
Boston, Mass

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