© 2004 by BMJ Publishing Group & British Cardiac Society
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ISCHAEMIC HEART DISEASE

Patients with acute coronary syndrome (ACS) need lipid lowering agents. How low should the LDL (low density lipoprotein) cholesterol value go? A total of 4162 patients who had ACS < 10 days before received either 40 mg of pravastatin (standard treatment) or 80 mg of atorvastatin daily (intensive treatment). The primary end point was a composite of death from any cause, myocardial infarction, documented unstable angina requiring rehospitalisation, revascularisation (performed at least 30 days after randomisation), and stroke. Follow up lasted a mean of two years. The median LDL cholesterol concentration achieved during treatment was 95 mg/dl (2.46 mmol/l) in the standard dose pravastatin group and 62 mg/dl (1.60 mmol/l) in the high dose atorvastatin group (p < 0.001). Kaplan-Meier estimates of the rates of the primary end point at two years were 26.3% in the pravastatin group versus 22.4% in the atorvastatin group (16% reduction in favour of atorvastatin,
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