"Intensive Lipid Lowering with Atorvastatin in Patients with Stable Coronary Disease". The New England Journal of Medicine. 2004. 350(15):1495-1504. PubMed
Links to original sources: Wiki Journal Post Full Journal Article
Contents 1 Clinical Question 2 Bottom Line 3 Major Points 4 Guidelines 5 Design 6 Population 6.1 Inclusion Criteria 6.2 Exclusion Criteria 6.3 Baseline Characteristics 7 Interventions 8 Outcomes 8.1 Primary Outcome 8.2 Secondary Outcomes 9 Funding 10 Further Reading
In patients hospitalized for an acute coronary syndrome, does intensive lipid-lowering therapy with atorvastatin improve cardiovascular outcomes compared to standard lipid-lowering therapy with pravastatin?
For patients recently hospitalized with an acute coronary syndrome, intensive lipid-lowering therapy with atorvastatin offers superior protection against death or major cardiovascular events than standard therapy with pravastatin.
The optimal level of LDL cholesterol for minimizing cardiovascular risk is unclear. Building on evidence that statin therapy reduces cardiovascular events, the PROVE IT–TIMI 22 trial was designed to compare the effects of intensive lipid-lowering therapy with atorvastatin against standard therapy with pravastatin among patients with recent acute coronary syndrome.
Current guidelines recommend a target LDL cholesterol level of less than 100 mg per deciliter for patients with established coronary artery disease or diabetes. However, findings from this study suggest potential benefits from achieving even lower levels.
- Multicenter, double-blind, randomized, placebo-controlled trial - N=4,162 patients with recent acute coronary syndrome - High-dose atorvastatin (80 mg daily) vs. standard-dose pravastatin (40 mg daily) - Median follow-up: 24 months
- Inclusion Criteria: Hospitalization for an acute coronary syndrome within the preceding 10 days - Exclusion Criteria: Certain co-morbid conditions, ongoing statin therapy > 80mg/day, certain medication restrictions, specific lab value abnormalities - Baseline Characteristics: Average age was 58, 22% were women, and 69% underwent percutaneous coronary intervention for their index acute coronary syndrome
Pravastatin 40 mg daily (standard therapy) versus atorvastatin 80 mg daily (intensive therapy)
- Primary Outcome: Composite of death from any cause, myocardial infarction, documented unstable angina requiring rehospitalization, revascularization (performed at least 30 days after randomization), and stroke - Secondary Outcomes: Death from coronary heart disease, nonfatal myocardial infarction, or revascularization; and other individual components
Supported by Bristol-Myers Squibb and Sankyo.
The full list of investigators and coordinators, as well as detailed trial information, is available at www.timi.org.