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High-dose statin therapy reduced first, subsequent CV events
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Intensive statin therapy was associated with a reduction in not only first CV events but subsequent events as well, according to an analysis of the IDEAL trial results.
Researchers for the post-hoc analysis applied the Wei, Lin and Weissfeld method to results from the IDEAL trial to determine comparative efficacy of either a high dose of 80-mg atorvastatin (Lipitor, Pfizer) or a standard dose of 20-mg to 40-mg simvastatin (Zocor, Merck) for the prevention of CV events beyond the first in 8,888 patients with a history of acute MI. Among the patients, 2,546 experienced a first CV event, 1,048 experienced a second event, 416 experienced a third event, 192 had a fourth event and 93 had a fifth event.
The researchers reported that patients assigned to 80-mg atorvastatin daily had a 17% RR reduction for a first event (P<.0001) vs. patients assigned to 20-mg to 40-mg simvastatin daily. In addition, patients in the high-dose group saw a 24% reduction in second events (P<.0001), 19% reduction in third events (P=.035) and 24% reduction in fourth events (P=.058). An omnibus test applied to the first through fifth events revealed an RR reduction of 17% for patients in the atorvastatin group vs. the simvastatin group across all events (P<.001). The majority of first events were coronary revascularizations (32%), followed by nonfatal MI (18%) and hospitalization for unstable angina (14%).
“We explored the possibility that new information concerning treatment efficacy of intensive statin therapy compared with standard statin therapy could be gained by analysis of repeated occurrences (after the first event) of CV events of different kinds,” the researchers wrote. “Our results indicate that intensive statin therapy continued to be more effective than standard statin therapy even beyond the first event.”
Tikkanen MJ. J Am Coll Cardiol. 2009;54:2353-2357.