Is event reduction related to LDL-cholesterol lowering?
In previous primary and secondary prevention trials with statins, the investigators correlated the degree of benefit to baseline lipid levels and to the change in lipid levels with treatment. This approach is unlikely to be fruitful in MIRACL for several reasons: (1) baseline lipid measurements might have been transiently depressed owing to the acute coronary event; (2) lipid levels during treatment were first measured at 6 weeks, by which time many of the endpoint events had already occurred; (3) factors other than serum lipids have a greater effect on acute coronary syndromes than on stable coronary disease; and (4) the statistical power for subgroup analyses is low because the treatment effect was barely statistically significant for the whole trial. Notwithstanding these limitations, there was no trend to suggest that atorvastatin treatment in MIRACL was of greater benefit in patients with higher baseline LDL-cholesterol levels. It is therefore reasonable to apply the MIRACL strate
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