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Total Cardiovascula...
Total Cardiovascular Disease Burden: Comparing Intensive With Moderate Statin Therapy Insights From the IDEAL (Incremental Decrease in End Points Through Aggressive Lipid Lowering) Trial
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- Tikkanen, Matti J (author)
- Univ Helsinki, Cent Hosp, Dept Med, Div Cardiol, FIN-00290 Helsinki, Finland
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- Szarek, Michael (author)
- Pfizer Inc, New York, NY USA
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- Fayyad, Rana (author)
- Pfizer Inc, New York, NY USA
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- Holme, Ingar (author)
- Ullevaal Univ Hosp, Ctr Prevent Med, Oslo, Norway
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- Cater, Nilo B (author)
- Pfizer Inc, New York, NY USA
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- Faergeman, Ole (author)
- Aarhus Univ Hosp, Dept Med Cardiol A, DK-8000 Aarhus, Denmark
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- Kastelein, John J P (author)
- Acad Hosp Amsterdam, Dept Vasc Med, Amsterdam, Netherlands
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- Olsson, Anders (author)
- Östergötlands Läns Landsting,Linköpings universitet,Internmedicin,Hälsouniversitetet,Endokrin- och magtarmmedicinska kliniken US
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- Lytken Larsen, Mogens (author)
- Department of Medicine-Cardiology A, Århus University Hospital, Århus, Denmark
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- Lindahl, Christina (author)
- Pfizer Sweden, Sollentuna, Sweden
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- Pedersen, Terje R (author)
- Ullevaal Univ Hosp, Ctr Prevent Med, Oslo, Norway
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(creator_code:org_t)
- Elsevier BV, 2009
- 2009
- English.
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In: Journal of the American College of Cardiology. - : Elsevier BV. - 0735-1097 .- 1558-3597. ; 54:25, s. 2353-2357
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Abstract
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- Objectives This post-hoc analysis of the IDEAL (Incremental Decrease in End Points Through Aggressive Lipid Lowering) trial was designed to assess the comparative treatment efficacy of high-dose atorvastatin and usual-dose simvastatin for the prevention of events subsequent to the first event, using the Wei, Lin, and Weissfeld method. Background Time-to-first-event analysis of data is frequently utilized to provide efficacy outcome information in coronary heart disease prevention trials. However, during the course of such long-term trials, a large number of events occur subsequent to the first event, the analysis of which will be precluded by this approach. Methods The Wei, Lin, and Weissfeld method allows the analysis of repeated occurrence of events of the same type or of entirely different natures. It regards the recurrence times as multivariate event (failure) times, and models the marginal (individual) distribution for each event with the Cox proportional hazards model. Results In the IDEAL trial, compared with patients taking simvastatin 20 to 40 mg daily, patients receiving atorvastatin 80 mg daily had their relative risk of a first cardiovascular event reduced by 17% (p less than 0.0001), of a second by 24% (p less than 0.0001), of a third by 19% (p = 0.035), of a fourth by 24% (p = 0.058), and of a fifth by 28% (p = 0.117). Conclusions Our results indicate that intensive statin therapy continues to be more effective than standard statin therapy, even beyond the first event, and suggest that clinicians should not hesitate to prescribe high-dose statin therapy for patients experiencing multiple recurrent cardiovascular events.
Keyword
- statins; cardiovascular events; WLW method
- MEDICINE
- MEDICIN
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- ref (subject category)
- art (subject category)
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Tikkanen, Matti ...
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Szarek, Michael
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Fayyad, Rana
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Holme, Ingar
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Cater, Nilo B
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Faergeman, Ole
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Kastelein, John ...
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Olsson, Anders
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Lytken Larsen, M ...
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Lindahl, Christi ...
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Pedersen, Terje ...
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Journal of the A ...
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Linköping University