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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EThe IDEAL (Incremental Decrease in Clinical Endpoints Through Aggressive Lipid Lowering) Trial\ncompared high and low doses of statins over a five-year time period. The primary endpoint was a\ncomposite of heart attack, coronary heart disease death, or cardiac arrest with resuscitation.\nSecondary endpoints included the primary events plus unstable angina that required hospitalization,\ncoronary artery bypass graft (CABG), or percutaneous coronary intervention (PCI).\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003Eclinical trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Elipid disorders\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n         \n         \u003Cp id=\u0022p-2\u0022\u003EThe IDEAL (Incremental Decrease in Clinical Endpoints Through Aggressive Lipid Lowering) Trial\ncompared high and low doses of statins over a five-year time period. The primary endpoint was a\ncomposite of heart attack, coronary heart disease death, or cardiac arrest with resuscitation.\nSecondary endpoints included the primary events plus unstable angina that required hospitalization,\ncoronary artery bypass graft (CABG), or percutaneous coronary intervention (PCI).\u003C\/p\u003E\n         \u003Cp id=\u0022p-3\u0022\u003EIDEAL \u201cbegins where 4S left off,\u201d according to lead investigator Torje Pedersen,\nMD, professor of medicine at Ulleval University Hospital and director of the Center for Preventive\nMedicine in Oslo, Norway. Pedersen was also lead investigator on the Scandinavian Simvastatin\nSurvival Study (4S), the 1994 study that demonstrated statin efficacy and launched the statin era.\n\u201cOne of our persistent questions at the end of 4S,\u201d Pedersen said, \u201cwas about\nstatin dose\u2014is the lipid-lowering effect of statins dose-related?\u201d\u003C\/p\u003E\n         \u003Cp id=\u0022p-4\u0022\u003EThe Pfizer-sponsored trial studied 8,888 patients, average age 62 and 19 percent female.\nParticipants received either 80 mg of atorvastatin vs. 20 mg of simvastatin. In those patients whose\ntotal cholesterol exceeded 193 mg\/dL and\/or LDL remained above 115 mg\/dL after six months, the\nsimvastatin dose was raised to 40 mg.\u003C\/p\u003E\n         \u003Cp id=\u0022p-5\u0022\u003EHigh-dose statins reduced the risk of cardiovascular events by 16% compared to low-dose\nstatins at the end of the study\u0027s 4.8 years of follow-up. In terms of the primary endpoint,\nhigh-dose statins produced an 11% decrease in events (P=0.07), not statistically\nsignificant in comparison with low-dose statins. \u201cThe overall benefits apparent in this trial\nwere more modest than we expected,\u201d Pedersen said, but he noted that after a post-hoc\nanalysis adjusting for risk factors in the primary endpoint, findings did reach statistical\nsignificance.\u003C\/p\u003E\n         \u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/16081\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/16081\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/16081\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\n               \u003Cp id=\u0022p-6\u0022 class=\u0022first-child\u0022\u003EIDEAL: Baseline and follow-up levels of LDL cholesterol\u003C\/p\u003E\n            \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-7\u0022\u003EOverall, high-dose statins reduced secondary endpoints by 16% and nonfatal heart attacks\nby 17%. The high-dose group saw average LDL reductions to 81 mg\/dL, compared with 104 mg\/dL\nin the low-dose simvastatin group. Pedersen said researchers observed a marked reduction in\nrevascularization procedures among high-dose study participants, and this group also saw no increase\nin risk of non-cardiac deaths compared to patients in the low-dose group\u2014an observation that\nshould \u201ccalm concerns that highdose statins contribute to excess non-cardiac deaths such as\ncancer,\u201d according to Pedersen.\u003C\/p\u003E\n         \u003Cp id=\u0022p-8\u0022\u003EPedersen also noted the relatively high number (24%) of study participants between the\nages of 70 and 80. \u201cGoing back 20 years, the average age of a patient with a heart attack\nmight have been 50,\u201d Pedersen said. \u201cNow it is closer to 70.\u201d With an aging\npopulation living longer thanks in part to advances in medical technology and treatment, Pedersen\nrecommended that clinical research consistently include older patients in study designs.\u003C\/p\u003E\n         \u003Cp id=\u0022p-9\u0022\u003EIn general, Pedersen said that \u201cour results were in line with other recent studies on the\nsame question that also found that high doses of statins improve outcomes.\u201d\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2005 MD Conference Express\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/5\/1\/27.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzm4g1\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_tables.js?nzm4g1\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}