IDEAL trial - Summary & Results


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A prospective,randomized, open-label, blinded-end-point evaluation trial on incremental decrease in endpoints through aggressive lipid lowering (IDEAL) using patients with a history of acute MI

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IDEAL trial - Summary & Results

  1. 1. IDEAL (Incremental Decrease inEndpoints through Aggressive LipidLowering)
  2. 2. IDEAL (Incremental Decrease in Endpoints throughAggressive Lipid Lowering)T Pedersen (Ullevål University Hospital, Oslo, Norway)American Heart Association 2005 Scientific Sessions• Background: IDEAL is a "lower-is-better" investigation comparing high-dose atorvastatin (80 mg) with simvastatin 20 mg, a dose widely used in clinical practice• A prospective, randomized, open-label, blinded-end-point evaluation trial• Population: 8888 patients aged 80 years or younger with a history of acute MI• Primary outcome: Composite of coronary death, nonfatal MI, or cardiac arrest with resuscitation
  3. 3. IDEAL: Results• At a five-year follow-up mean LDL-C was 80.0 mg/dL in atorvastatin patients and 99.8 mg/dL in simvastatin patients• There was no statistical difference in the incidence of the primary end point between the two armsPrimary outcomeaOutcome (%) Simvastatin (n=4449) Atorvastatin (n=4439) Hazard ratio (95% CI)Major coronary eventb 10.4 9.3 0.89 (0.78–1.01)CHD death 4.0 3.9 0.99 (0.80–1.22)Nonfatal MI 7.2 6.0 0.83 (0.71–0.98)Cardiac arrest with resuscitation 0.2 0.2 NAa. At a median of 4.8 yearsb. Coronary death, nonfatal MI, or cardiac arrest with resuscitation
  4. 4. IDEAL: Results• The composite secondary end point of a major CV eventa was significantly reduced in patients treated with atorvastatinSecondary outcomesbOutcome (%) Simvastatin (n=4449) Atorvastatin (n=4439) Hazard ratio (95% CI)Any CHD event 23.8 20.2 0.84 (0.76–0.91)Coronary revascularization 16.7 13.0 0.77 (0.69–0.86)Hospitalization for unstable angina 5.3 4.4 0.83 (0.69–1.01)Fatal or nonfatal stroke 3.9 3.4 0.87 (0.70–1.08)Major CV event 13.7 12.0 0.87 (0.78–0.98)Any CV event 30.8 26.5 0.84 (0.78–0.91)a. Major coronary events and strokeb. At a median of 4.8 years
  5. 5. IDEAL: Commentary*"Nothing magical seems to happen here that would make us shift our focus awayfrom LDL-lowering effects. The important point is to lower LDL cholesterol tosufficiently low levels to provide incremental benefit." - Dr James de Lemos"Saying that it is difficult is not saying that we shouldnt try. . . . What the guidelinesare really telling clinicians is to get the LDL cholesterol down as low as you safelycan." - Dr Steven Nissen *All comments from IDEAL: Intensive lipid lowering after acute MI did not reduce the risk of major coronary events (
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