The mean LDL cholesterols were 77 mg/dL during treatment with 80 mg of atorvastatin and 101 mg/dL during treatment with 10 mg of atorvastatin. There was a 22% reduction in a composite cardiovascular endpoint and a 20% reduction in cardiac deaths with more intensive therapy but no reduction in all-cause mortality.400 In the IDEAL (Incremental Decrease in End Points Through Aggressive Lipid Lowering) study patients with a past history of MI were randomly assigned to intensive lipid-lowering therapy with atorvastatin 80 mg daily or simvastatin 20 mg daily. During treatment, mean LDL cholesterol levels were 104 mg/dL in the simvastatin group and 80 mg/dL in the atorvastatin group. The results showed a nonsignificant trend toward reduction of the primary com- posite endpoint of coronary death, nonfatal MI, or cardiac arrest (hazard ratio: 0.89; 95% CI: 0.78 to 1.01); significant reductions in some secondary endpoints such as nonfatal MI and coronary revascularization; and no effect on all-cause mortality.501 It should be noted that both these trials com- pared 2 drug regimens and did not directly test the benefit of achieving a given level of LDL cholesterol and that, to date, there is no clear evidence that treating to a specific target, as opposed to treating with a higher dose of a higher-potency statin, is beneficial. The mean achieved LDL cholesterol levels among patients treated in the high-dose atorvastatin arms of the TNT and IDEAL studies were 77 and 81 mg/dL, respectively. These data support intensive LDL cholesterol lowering with statins in patients with SIHD. An update of the ATP-III report18,24 recommends treatment to an LDL cholesterol level ,100 mg/dL in patients with established CAD or other high-risk features, with an LDL cholesterol goal of ,70 mg/dL as a therapeutic option in patients at very high risk. 