[The IDEAL study comparing simvastatin 20-40 mg versus atorvastatin 80 mg for secondary prevention after myocardial infarction: between two ideas of the ideal].
The IDEAL ("Incremental Decrease in End Points Through Aggressive Lipid Lowering") study compared the effects of two strategies of lipid lowering on the risk of cardiovascular disease among patients with a previous myocardial infarction. In this prospective, randomized, open-label, blinded end-point evaluation trial, patients were randomly assigned to receive a high dose of atorvastatin (80 mg/day; n = 4439), or an usual dose of simvastatin (20 mg/day, titrated up to 40 mg/day if necessary; n = 4449). During treatment, mean LDL cholesterol levels were 104 mg/dl in the simvastatin group and 81 mg/dl in the atorvastatin group (p < 0.001). After a median follow-up of 4.8 years, no significant difference was observed in the primary outcome of major coronary events (defined as coronary death, confirmed nonfatal acute myocardial infarction, or cardiac arrest with resuscitation), but the risk of other composite secondary end points (i.e., major cardiovascular events, all cardiovascular events, all coronary events) was statistically reduced in the atorvastatin group compared to the simvastatin group. There were no differences in cardiovascular or all-cause mortality between the two groups. In conclusion, patients with myocardial infarction may benefit from intensive lowering of LDL cholesterol without an increase in noncardiovascular mortality or other serious adverse reactions.
Scheen
A J
AJ
Université de Liège, Chef de Service, Service de Diabétologie, Nutrition et Maladies métaboliques et Unité de Pharmacologie clinique, Département de Médecine.
D000924:Anticholesteremic Agents / Q000627:therapeutic use*; D000069059:Atorvastatin; D002318:Cardiovascular Diseases / Q000517:prevention & control; D008078:Cholesterol, LDL / Q000097:blood / Q000187:drug effects; D005260:Female; D006538:Heptanoic Acids / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000517:prevention & control*; D011446:Prospective Studies; D011758:Pyrroles / Q000627:therapeutic use*; D012307:Risk Factors; D019821:Simvastatin / Q000627:therapeutic use*; D016037:Single-Blind Method; D016896:Treatment Outcome
D000924:Anticholesteremic Agents; D008078:Cholesterol, LDL; D006538:Heptanoic Acids; D011758:Pyrroles; D000069059:Atorvastatin; D019821:Simvastatin