High-dose lipid-lowering therapy with atorvastatin (Lipitor) not only prevents a first cardiovascular (CV) event from occurring compared with simvastatin (Zocor), but it also continues to prevent repeat events in high-risk patients, according to a trial presented at the 2008 Congress of the European Atherosclerosis Society (EAS).
Matti Tikkanen, MD, from the department of medicine at Helsinki Central Hospital in Helsinki, Finland, presented the findings of a post hoc analysis from the Incremental Decrease in Endpoints Through Aggressive Lipid Lowering (IDEAL) trial.
In the IDEAL study, 8,888 patients with a history of MI were randomized to receive atorvastatin 80 mg/day or simvastatin given at the standard 20 to 40 mg (S20-40).
Major coronary events over the five-year study period were prevented in significantly more patients in the atorvastatin arm than in the S20-40 arm, and few patients experienced any CV event, Tikkanen said during his April 28 presentation.
Tikkanen said that clinical trials usually focus on the time to the first event, mainly for methodological reasons, but this precludes a lot of potentially useful clinical information. During the course of a long-term trial, many patients have more than one event.
The aim of the post hoc analysis was therefore to see if the more intensive lipid-lowering atorvastatin regimen continued to be of benefit in preventing CV events beyond the first event over the course of the five-year study, according to Tikkanen.
In total, the researchers observed 2,546 first CV events, as well as 1,048 second, 416 third, 192 fourth and 93 fifth events.
Overall, the relative risk reduction in second events was 24 percent lower in patients treated with atorvastatin 80 mg versus S20-40, Tikkanen said.
The relative risk reduction was 19 percent lower with atorvastatin for third events, although this was not statistically significant when compared with S20-40.
Tikkanen noted that physicians who treat patients who have multiple CV events should ensure that patients adhere to sufficiently high-dose statin regimens, as such patients "continue to benefit from long-term intensive statin therapy."
Pfizer funded the IDEAL trial.