[Thoughts about the results of the "IDEAL" study].

INTRODUCTION: Evidences and guidelines suggest that more intensive lowering of LDL-cholesterol will provide further benefit in coronary artery disease.

AIM AND METHOD: 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).

CONCLUSION: 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.