Reduction in recurrent cardiovascular events with intensive lipid-lowering statin therapy compared with moderate lipid-lowering statin therapy after acute coronary syndromes from the PROVE IT-TIMI 22 (Pravastatin or Atorvastatin Evaluation and Infection Therapy-Thrombolysis In Myocardial Infarction 22) trial.

Abstract

OBJECTIVES:

In addition to reducing first events in patients after an acute coronary syndrome (ACS), we hypothesized that high-dose atorvastatin 80 mg would also reduce recurrent cardiovascular events, and therefore total events, compared with pravastatin 40 mg during the 2-year follow-up.

BACKGROUND:

In the PROVE IT-TIMI 22 (Pravastatin or Atorvastatin Evaluation and Infection Therapy-Thrombolysis In Myocardial Infarction 22) trial, more intensive lipid lowering with high-dose atorvastatin reduced the first occurrence of the primary end point (death, myocardial infarction, unstable angina requiring rehospitalization, stroke, or revascularization > or = 30 days) compared with moderate lipid lowering with pravastatin.

METHODS:

Poisson regression analysis was performed to compare the number of occurrences of the primary end point between high-dose atorvastatin and pravastatin in the PROVE IT-TIMI 22 trial.

RESULTS:

As previously reported, first primary end point events were reduced by 16% with atorvastatin 80 mg versus pravastatin 40 mg (n = 464 vs. n = 537, respectively; p = 0.005). Additional events were also reduced by 19% with atorvastatin 80 mg (n = 275 vs. n = 340, respectively; p = 0.009). Overall, there were 138 fewer primary efficacy events with atorvastatin 80 mg versus pravastatin 40 mg (n = 739 vs. n = 877, respectively; rate ratio: 0.85, 95% confidence interval: 0.77 to 0.94, p = 0.001).

CONCLUSIONS:

Although analytic techniques commonly used in clinical outcomes trials censor patients who experience a component of the primary composite end point, total cardiovascular events are important to patients, clinicians, and health care payers. Maintaining low levels of low-density lipoprotein cholesterol is central to preventing additional atherosclerotic development and subsequent cardiovascular events. Atorvastatin 80 mg, a more intensive low-density lipoprotein cholesterol lowering agent, reduced both first and subsequent primary end point events compared with pravastatin 40 mg after ACS.

• Authors: Sabina A Murphy, Christopher P Cannon, Stephen D Wiviott, Carolyn H McCabe, Eugene Braunwald
• Journal: Journal of the American College of Cardiology (J Am Coll Cardiol) Vol. 54 Issue 25 Pg. 2358-62 (Dec 15 2009) ISSN: 1558-3597 [Electronic] United States
• PMID: 20082923 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Heptanoic Acids
• Hydroxymethylglutaryl-CoA Reductase Inhibitors
• Pyrroles
• C-Reactive Protein
• Cholesterol
• Atorvastatin
• Pravastatin

Topics

• Acute Coronary Syndrome (drug therapy)
• Aged
• Angina, Unstable (prevention & control)
• Atorvastatin
• C-Reactive Protein (analysis)
• Cholesterol (blood)
• Dose-Response Relationship, Drug
• Female
• Heptanoic Acids (administration & dosage)
• Hospitalization (statistics & numerical data)
• Humans
• Hydroxymethylglutaryl-CoA Reductase Inhibitors (administration & dosage)
• Male
• Myocardial Infarction (prevention & control)
• Myocardial Revascularization (statistics & numerical data)
• Pravastatin (administration & dosage)
• Pyrroles (administration & dosage)
• Regression Analysis
• Secondary Prevention
• Stroke (prevention & control)