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(Circulation. 2006;113:1382-1384.)
© 2006 American Heart Association, Inc.

Editorial

Direct Comparison of the A to Z and PROVE IT Trials

A Second Chance to Gain a First Impression

B. Greg Brown, MD, PhD

From the Cardiology Division, Department of Medicine, University of Washington, Seattle.

Correspondence to B. Greg Brown, MD, PhD, Cardiology Division, Department of Medicine, University of Washington, Box 358855, Seattle, WA 98195-8855. E-mail bgbrown@u.washington.edu

Key Words: Editorials • angioplasty • atherosclerosis • lipoproteins

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 
Two similar clinical trials in patients presenting with acute coronary syndromes (ACS), the Aggrastat to Zocor (A to Z)¹ and Pravastatin or Atorvastatin Evaluation and Infection Therapy (PROVE IT)–TIMI 22² trials, each compared intensive versus moderate statin therapies for 2 years. PROVE IT demonstrated a significant benefit from intensive therapy (16% reduction, P=0.005 in its primary end point), whereas A to Z found only a favorable trend (11% reduction, P=0.14 in its somewhat different primary end point). Like many clinicians reading these 2 reports, my first impression was that these data demonstrated the superiority of 80 mg of atorvastatin over 80 mg of simvastatin. Market share shifts soon reflected this perception. Wiviott et al³ have compared these studies in detail to ask whether the observed differences were explained by true differences in drug efficacy or, alternatively, by differences in trial design or practice differences among the 2 studies’ clinical sites (factors that, in this analysis, may be linked to different practice patterns inside or outside the United States). Event rates in the "early" 4-month phase and the "late" 20-month phase were examined separately. This is a well-written and well-reasoned post hoc comparison between 2 "similar" trials that nevertheless have certain important hypothesis-generating differences.

Article p 1406

First, it should be noted that the between-trial comparisons of the overall benefits of intensive therapy, though tending to favor PROVE IT, were not statistically significant in 2 of the 3 between-trial endpoint comparisons (P=0.52, 0.03, and 0.55). The PROVE . . . [Full Text of this Article]

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