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High-Dose Atorvastatin Reduces Cardiovascular Risks

Comparison with standard-dose simvastatin shows benefits, but mostly in younger patients

MONDAY, Mar. 9 (HealthDay News) -- In heart attack patients with stable coronary disease, treatment with high-dose atorvastatin may be associated with greater benefits than treatment with standard-dose simvastatin, especially among younger patients, according to the results of a study published in the Mar. 1 issue of the American Journal of Cardiology.

Matti J. Tikkanen, M.D., Ph.D., of Helsinki University Central Hospital in Helsinki, Finland, and colleagues from the Incremental Decrease through Aggressive Lipid Lowering (IDEAL) study randomly assigned 8,888 patients to receive either 80 mg a day of atorvastatin or 20 to 40 mg a day of simvastatin.

Compared to standard-dose simvastatin, the researchers found that high-dose atorvastatin had a greater effect in patients under age 65 than in those over age 65 at reducing the risk of a first major coronary event (hazard ratios, 0.80 and 0.95, respectively), and occurrence of any cardiovascular event (hazard ratios, 0.80 and 0.88, respectively). But the investigators observed that lower atorvastatin adherence rates in older patients may have affected the results.

"In routine clinical care settings, it is a common experience that adherence to statin therapy is unsatisfactory in elderly patients, and a significant proportion of patients discontinue therapy as early as six months after initiation," the authors write. "In our open-label trial, adherence was relatively good, but why was adherence lower in patients receiving atorvastatin, particularly in older patients? The proportion of patients reporting serious adverse events was virtually the same in the two treatment groups, but more atorvastatin than simvastatin patients discontinued treatment prematurely."

This study was supported by Pfizer, Inc., the maker of atorvastatin; several study authors have disclosed financial relationships with Pfizer and other pharmaceutical companies.

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