The SEARCH study compared simvastatin 20mg to simvastatin 80mg over a period of 6.7 years for secondary prevention of cardiovascular events. This study found no significant difference in major vascular events but a higher risk of side effects including myopathy and rhabdomyolysis with the higher dose.
The meta-analysis reviewed the benefits of statin therapy and included the SEARCH results. The review concluded that reductions in LDL cholesterol of 1mmol/L result in a reduction in major cardiovascular events of approximately 20%. They also note that more intensive statin therapy in selected high-risk populations might bring additional benefits.
Action: This new evidence supports the current NICE Lipid Modification guideline. Simvastatin 40mg daily remains the first line choice in the majority of people with higher intensity treatment reserved for consideration in those at higher risk after assessment of risks and benefits.