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June 7, 2006

High-Dose Statins and the IDEAL Study

Author Affiliations

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2006;295(21):2476-2479. doi:10.1001/jama.295.21.2477-b

To the Editor: The IDEAL study1 reported that high-dose atorvastatin (80 mg/d) was more beneficial in preventing recurrent nonfatal myocardial infarction than was low-dose simvastatin (20 mg/d). The achieved mean low-density lipoprotein cholesterol (LDL-C) level was 81 mg/dL vs 104 mg/dL, respectively.

Clinicians face the question of how low the target LDL-C level should be. Unfortunately, studies assess event rates in the more intensively treated group vs the less intensively treated group, rather than assessing outcome based on LDL-C level achieved. It is likely that there were many more individuals with an achieved LDL-C well above 100 mg/dL in the simvastatin group than in the atorvastatin group. The greater number of events in the simvastatin group may have been a result of the larger proportion of patients with persisting elevation of LDL-C, rather than a result of the mean LDL-C of 104 mg/dL not being low enough.