Previous studies have demonstrated that benefits of intensive statin therapy compared
to standard statin therapy begin shortly after an acute event and are continued up
to 2 years of follow-up. However, whether efficacy and safety of intensive statin
therapy in patients with a recent cardiac event are maintained in longer-term follow-up
has not been evaluated. We conducted a post hoc analysis of a subgroup of 999 patients
who had a first acute myocardial infarction (MI) <2 months before randomization in
a prospective, open-label, blinded end-point evaluation trial of 8,888 patients with
a history of MI that compared intensive statin therapy (atorvastatin 80 mg) to standard
statin therapy (simvastatin 20 to 40 mg) over approximately 5 years of follow-up.
We analyzed the same composite end point used in the Pravastatin or Atorvastatin Evaluation
and Infection Therapy (PROVE IT) trial (death, MI, hospitalization for unstable angina,
revascularization, and stroke). Rates of the composite end point were 44.7% (n = 226)
in the simvastatin group and 37.9% (n = 187) in the atorvastatin group (hazard ratio
0.82, 95% confidence interval 0.67 to 0.99, p = 0.04). Although statistical power
was smaller than that of the PROVE IT trial, the relative risk decrease observed at
5 years is consistent with that in the 2-year follow-up in PROVE IT. The 2 treatment
regimens were well tolerated. In conclusion, our analysis provides support for the
strategy of placing patients with recent MI on intensive statin therapy and maintaining
the high dose over the long term, beyond 2 years.
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Article info
Publication history
Accepted:
March 15,
2010
Received in revised form:
March 15,
2010
Received:
December 22,
2009
Footnotes
The IDEAL study was funded by Pfizer, Inc., New York, New York.
Identification
Copyright
© 2010 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
