Letter by Del Pinto et al Regarding Article, “Prevention of Stroke With the Addition of Ezetimibe to Statin Therapy in Patients With Acute Coronary Syndrome in IMPROVE-IT (Improved Reduction of Outcomes: Vytorin Efficacy International Trial)”
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To the Editor:
We read with great interest the article by Bohula and colleagues,1 reporting on the efficacy and safety of adding ezetimibe to simvastatin for the reduction of ischemic stroke incidence in patients with established ischemic heart disease with or without previous cerebrovascular events. The authors also observed a nonsignificant increase in hemorrhagic stroke when ezetimibe was added to background statin treatment. Among other factors, a history of hypertension predicted the occurrence of hemorrhagic but not ischemic stroke. Conversely, the authors hypothesized that the specific mechanism of low-density lipoprotein cholesterol lowering that is …