[Thoughts about the results of the "IDEAL" study].
BACKGROUND
Evidences and guidelines suggest that more intensive lowering of LDL-cholesterol will provide further benefit in coronary artery disease.


OBJECTIVE
In the IDEAL study patients with previous myocardial infarction were randomly assigned to receive 80 mg of atorvastatin (n = 4439) or 20-40 mg simvastatin (n = 4449). The median follow-up was 4.8 years. The objective was to compare the effects of two strategies of lipid lowering therapy.


RESULTS
During treatment mean LDL-cholesterol levels were 2.7 mmol/l in the simvastatin group and 2.1 mmol/l in the atorvastatin group. A major coronary event occurred in 463 (10.4%) simvastatin patients and in 411 (9.3%) atorvastatin patients (p = 0.07). Death from any cause occurred 374 (8.4%) in the simvastatin group and 366 (8.2%) in the atorvastatin group (p = 0.81). Nonfatal acute myocardial infarction occurred 321 (7.2%) and 267 (6.0%) in the two groups (p = 0.02). Patients in the atorvastatin group had higher rates of drug discontinuation due to non-serious adverse events; transaminase elevation resulted in 43 (1.0%) versus 5 (0.1%) withdrawals (p <0.001).


CONCLUSIONS
Patients with high risk or very high risk may benefit from intensive lowering of LDL-cholesterol without an increase of adverse reaction but try to find the ideal statin and dose of statin.
Kalina
Akos
A
MAV Kórhaz es Központi Rendelointézet, Kardiológia, Budapest. kalinaak@axelero.hu
D000924:Anticholesteremic Agents / Q000627:therapeutic use*; D000069059:Atorvastatin; D008078:Cholesterol, LDL / Q000097:blood; D005500:Follow-Up Studies; D006538:Heptanoic Acids / Q000627:therapeutic use*; D006801:Humans; D009203:Myocardial Infarction / Q000517:prevention & control*; D011758:Pyrroles / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D019821:Simvastatin / Q000627:therapeutic use*; D016896:Treatment Outcome
D000924:Anticholesteremic Agents; D008078:Cholesterol, LDL; D006538:Heptanoic Acids; D011758:Pyrroles; D000069059:Atorvastatin; D019821:Simvastatin