NEW YORK (Reuters Health) – The safety and efficacy of intensive statin therapy initiated soon after a first MI are maintained at 5 years, Scandinavian investigators report.

They note in the American Journal of Cardiology for August 1 that previous studies have shown that intensive statin therapy after acute MI is beneficial for up to 2 years. To look at longer-term outcomes, Dr. Terje R. Pedersen at the University of Oslo, Norway and colleagues conducted a post hoc analysis of data from the IDEAL (Incremental Decrease in End Points Through Aggressive Lipid Lowering) trial.

IDEAL involved 8,888 patients with a history of MI and compared intensive statin therapy (atorvastatin 80 mg) to standard statin therapy (simvastatin 20 to 40 mg) over approximately 5 years of follow-up. The current study focused on a subgroup of 999 patients who began statin therapy less than 2 months after their MI.

“At the end of the trial, 27% of patients being prescribed simvastatin were taking 40 instead of 20 mg/day, whereas 12% of those being prescribed atorvastatin were taking 40 instead of 80 mg/day,” the investigators explain.

The composite endpoint of death, MI, hospitalization for unstable angina, revascularization, or stroke occurred in 44.7% of the simvastatin group and 37.9% of the atorvastatin group (hazard ratio 0.82, p=0.04),

“The most important component of the primary end point was recurrent nonfatal acute MI occurring in 12.3% in the simvastatin group and in 6.7% in the atorvastatin group (HR 0.54, p=0.004),” Dr. Pedersen and colleagues found.

Both statin regimens were well tolerated. Adverse events leading to discontinuation of study drug were reported in 4.6% in the simvastatin group and 7.3% in the atorvastatin group, which was not a significant difference.

“There were no reports of myopathy in the atorvastatin-treated patients,” the investigators note. “In the simvastatin group, investigators reported 2 cases of myopathy, 1 of which was reported to be rhabdomyolysis.”

The researchers point out that the post hoc nature of the analysis means that the findings should be considered as hypothesis-generating. Still, they conclude, “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.”

The IDEAL study was funded by Pfizer.

Reference:

Comparison of Atorvastatin 80 mg/day Versus Simvastatin 20 to 40 mg/day on Frequency of Cardiovascular Events Late (Five Years) After Acute Myocardial Infarction (from the Incremental Decrease in End Points Through Aggressive Lipid Lowering [IDEAL] Trial)

Am J Cardiol 2010;106:354-359.