High-Dose Atorvastatin vs Usual-Dose Simvastatin for Secondary Prevention After Myocardial InfarctionThe IDEAL Study: A Randomized Controlled Trial

Abstract

Lowering of low-density lipoprotein cholesterol (LDL-C) with statins has in the last decade become part of the standard treatment regimen in patients with established coronary heart disease (CHD). Following the publication of the results of the Scandinavian Simvastatin Survival Study (4S) in 1994,¹ the most common treatment regimen for such patients in northern Europe has been simvastatin, 20 to 40 mg/d. In a recent trial among patients with acute coronary syndromes, incremental benefit was demonstrated with more intensive lowering of LDL-C to well below 100 mg/dL.² In the Treating to New Targets (TNT) study comparing high and low doses of atorvastatin in stable nonacute CHD, a significant improvement in prognosis with respect to cardiovascular disease was demonstrated.³ In that study, however, the benefit of reduced cardiovascular mortality appeared to have been offset by a higher number of deaths due to noncardiovascular causes. Although this difference did not reach statistical significance and could well be due to the play of chance, it led to a call for further safety information on the use of atorvastatin at a dose of 80 mg/d.⁴