The IDEAL Cholesterol Christopher Cannon, M.D. TIMI Study Group Brigham and Women’s Hospital Cannon CP. JAMA 2005;294:

Four trials: “Lower is Better” LDL-C Reduction,Risk Reduction Risk Reduction in Trial’sin CHD Trial PopulationDuration, ymg/dLPrimary End Point, %Death or MI, % PROVE IT–TIMI 22ACS (N = 4162) A to Z ACS (N = 4497) TNT Stable CAD (N = ) IDEALStable CAD (N = 8888) Cannon CP. JAMA 2005;294:

Coronary Heart Disease (CHD) Event Rates in Secondary Prevention and ACS Trials Updated from - O’Keefe, J. et al., J Am Coll Cardiol 2004;43: y = x · R² = p < LDL Cholesterol (mg/dl) CHD Events (%) PROVE-IT-PR PROVE-IT-AT CARE-S LIPID-S HPS-S 4S-S HPS-P CARE-P LIPID-P 4S-P TNT 80 TNT 10A2Z 80 A2Z 20 IDEAL S20/40 IDEAL A80

Take Home Messages: Physicians (1) 1. For LDL cholesterol, “lower is better” for preventing CV events. Mounting evidence (HPS, ASCOT, PROVE IT-TIMI 22, TNT, and now IDEAL) should likely prompt future changes in National Cholesterol Education Program and ACC/AHA cholesterol treatment guidelines. Mounting evidence (HPS, ASCOT, PROVE IT-TIMI 22, TNT, and now IDEAL) should likely prompt future changes in National Cholesterol Education Program and ACC/AHA cholesterol treatment guidelines. 2. Benefit in both ACS and stable CAD Cannon CP. JAMA 2005;294:

Take Home Messages: Physicians (2) 3. Benefit dramatic on stroke: 3. Benefit dramatic on stroke: lCTT – 17% reduction in stroke with standard dose vs. placebo lIDEAL, TNT – ADDITIONAL ~20% reduction in stroke 4. Provides support to adopt the NCEP update in 2004 l< 100 mg/dL for individuals with risk factors l< 70 mg/dL if heart disease is present. 5. Continue research on novel approaches (HDL, CRP etc) Cannon CP. JAMA 2005;294:

Take Home Messages: Patients (1) 1. For LDL cholesterol, “lower is better” for preventing heart attacks, strokes and death. Mounting evidence may prompt future changes in National Cholesterol Education Program cholesterol-level guidelines. Mounting evidence may prompt future changes in National Cholesterol Education Program cholesterol-level guidelines. 2. Know your numbers ! For both “bad” (LDL) and “good” (HDL) cholesterol Cannon CP. JAMA 2005;294:

Take Home Messages: Patients (1) 3. Work with your doctor to try to reduce their LDL cholesterol to new guideline suggested levels – 1.< 100 mg/dL for individuals with risk factors 2.< 70 mg/dL if heart disease is present. This strategy is key to prevent future cardiovascular events. Cannon CP. JAMA 2005;294:

Take Home Messages: Patients (3) 4.Statins are considered safe with side effects usually resolving with dose changes or switching to a different drug. 5.A good diet and exercise is part of the overall “heart healthy” plan. 6.In addition, raising the “good” (HDL) cholesterol may be beneficial on top of lowering the bad cholesterol. Cannon CP. JAMA 2005;294:

IDEAL Editorial - JAMA “There are now four trials and more than 27,000 patients showing that high-dose statins lower cholesterol more than regular- dose statins and provide additional benefit in preventing heart attacks,” “These studies reaffirm the central role of lowering cholesterol as a means of reducing morbidity and mortality from heart disease.” Cannon CP. JAMA 2005;294:

Articles, slides, Video presentation Available on: October 19 th 2005