Intensive statin therapy seems to reduce longer-term repeat MI risk

The safety and efficacy of intensive statin therapy initiated soon after a first heart attack are maintained in the longer-term, according to new research.

Writing in the American Journal of Cardiology, Scandinavian researchers note that previous studies have shown that intensive statin therapy after acute MI is beneficial for up to 2 years. 

Dr. Terje Pedersen at the University of Oslo, Norway and colleagues looked at five year outcomes by conducting a post hoc analysis of data from the IDEAL (Incremental Decrease in End Points Through Aggressive Lipid Lowering) trial funded by Pfizer.

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.

The report said 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.”