Statins - The IDEAL study
For the past year in the US, the cholesterol mantra has been to push the LDL cholesterol below 70 ( = 3.5 in our money) for patients who are known to have diseased coronary arteries. The recommendations were somewhat controversial - having been made by a panel of doctors who had ties to the statin industry - but they were widely adopted.
The IDEAL study does seem to call the mantra into question.
Even though the high dose Lipitor did lower the LDL more than the Zocor, the final results were about the same: There were 178 coronary deaths (4.0%) in the simvastatin group vs 175 (3.9%) in the atorvastatin group.
Nonfatal myocardial infarction occurred in 321 patients (7.2%) in the simvastatin group and in 267 (6.0%) in the atorvastatin group.
Interestingly, people were less tolerant of Lipitor. They were more likely to experience muscle aches and liver enzyme elevations. And they were more likely to stop taking it.
Overall adherence, defined as total study medication exposure as a percentage of total follow-up time, was 89% in the atorvastatin group and 95% in the simvastatin group. By the end of the study, 14% of the atorvastatin-allocated and 7% of the simvastatin-allocated patients had permanently discontinued study medication.
Read the study here:
http://jama.ama-assn.org/cgi/content/full/294/19/2437
posted by John Blenkinsopp @ Thursday, November 17, 2005
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