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After a median follow-up of 4.8 years, no significant difference was observed in the primary outcome of major coronary events (defined as coronary death, confirmed nonfatal acute myocardial infarction, or cardiac arrest with resuscitation), but the risk of other composite secondary end points (i.e., major cardiovascular events, all cardiovascular events, all coronary events) was statistically reduced in the atorvastatin group compared to the simvastatin group. During treatment, mean LDL cholesterol levels were 104 mg/dl in the simvastatin group and 81 mg/dl in the atorvastatin group (p < 0.001). In this prospective, randomized, open-label, blinded end-point evaluation trial, patients were randomly assigned to receive a high dose of atorvastatin (80 mg/day n = 4439), or an usual dose of simvastatin (20 mg/day, titrated up to 40 mg/day if necessary n = 4449). The IDEAL ("Incremental Decrease in End Points Through Aggressive Lipid Lowering") study compared the effects of two strategies of lipid lowering on the risk of cardiovascular disease among patients with a previous myocardial infarction.