When a patient turns up with chest pain, he or she might be having a heart attack or might just have angina, a pain that says your heart isn't getting quite enough oxygen. Either way, one way to treat the patient is to prescribe a cholesterol-lowering statin drug. A 41-country trial of intensive therapy with simvastatin (Zocor) shows that it may not actually help.

What the researchers wanted to know: Does starting Zocor early and taking it intensively decrease the risk of further heart problems for people who've had trouble already?

What they did: About 4,500 patients in 41 countries from Argentina to Finland to Singapore joined the study a few days after having either a heart attack or an episode of "acute coronary syndrome"—which means they'd had some episode in which the heart wasn't getting enough oxygen. All of them had cholesterol below 250 to start with. Each was randomly assigned to one of two treatments: an early, aggressive treatment, in which they got 40 milligrams of simvastatin a day for 30 days, then 80 mg a day after that, or a placebo for four months, then 20 mg a day of simvastatin. The patients (and their doctors) didn't know which treatment they were on. Most of them were also given ACE inhibitors, beta blockers, and aspirin. The researchers were looking for a difference in a composite "endpoint"—having a heart attack or stroke, going back to the hospital for acute coronary syndrome, or being killed by your cardiovascular system.

What they found: Fourteen percent of the intensive-Zocor-only group had a serious cardiovascular episode, compared with 17 percent of the patients who took a placebo, then lower-dose Zocor. That's not a very big difference, and it could have easily be due to chance.

What the study means to you: Aggressive treatment with Zocor after a heart attack or a bout with acute coronary syndrome may not be any better than more gentle treatment.

Caveats: Fewer patients died or had heart attacks, strokes, and acute coronary syndrome than expected, so the researchers didn't get as much out of the data as they'd anticipated. Eleven of the paper's 16 main authors have financial relationships with Merck—including being paid honoraria, receiving grant funding, or being employed by Merck, which makes Zocor.

Find out more: The British Heart Foundation defines acute coronary syndrome http://www.bhf.org.uk/

Information on Zocor from Medline: http://www.nlm.nih.gov

Read the article: de Lemos, J.A. et al. "Early Intensive vs. a Delayed Conservative Simvastatin Strategy in Patients With Acute Coronary Syndromes: Phase Z of the A to Z Trial." Journal of the American Medical Association. Sept. 15, 2004, Vol. 292, No. 11, pp. 1307–1316.

Abstract online: http://jama.ama-assn.org