Intensive lipid lowering with Atorvastatin 80 mg did not result in a significant reduction in the primary end point of major coronary events when compared with usual-dose Simvastatin in patients with a previous myocardial infarction.

The IDEAL study compared the effects of 2 strategies of lipid lowering on the risk of cardiovascular disease among patients with a previous myocardial infarction.

The prospective study was conducted at 190 ambulatory cardiology care and specialist practices in northern Europe between March 1999 and March 2005 with a median follow-up of 4.8 years, which enrolled 8888 patients aged 80 years or younger with a history of acute myocardial infarction.

Patients were randomly assigned to receive a high dose of Atorvastatin ( Lipitor; 80 mg/d; n = 4439 ), or usual-dose Simvastatin ( Zocor; 20 mg/d; n = 4449 ).

The main outcome measure was occurrence of a major coronary event, defined as coronary death, confirmed nonfatal acute myocardial infarction, or cardiac arrest with resuscitation.

During treatment, mean LDL-C levels were 104 mg/dL in the Simvastatin group and 81 mg/dL in the Atorvastatin group.

A total of 463 ( 10.4% ) patients who took Simvastatin and 411 ( 9.3% ) patients who took Atorvastatin died of coronary heart disease or had an acute myocardial infarction or suffered a cardiac arrest that required resuscitation.
The difference was not statistically significant.

The composite secondary end point of a major cardiovascular event, defined as major coronary events and stroke, was significantly reduced in patients treated with Atorvastatin.

The risk of death from any cause was similar in both study groups. There were no significant differences in non-cardiovascular deaths between the treatment groups.

Patients in the Atorvastatin group had higher rates of drug discontinuation due to nonserious adverse events; transaminase elevation resulted in 43 ( 1.0% ) vs 5 ( 0.1% ) withdrawals ( P<.001 ). Serious myopathy and rhabdomyolysis were rare in both groups.

The study has shown that patients with myocardial infarction may benefit from intensive lowering of LDL-cholesterol without an increase in non-cardiovascular mortality or other serious adverse reactions.
However, the study also suggests that there is no need for patients to stay on a high dose of Atorvastatin.

Source: The Journal of American Medical Association, 2005


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