Aim

To compare the effects of aggressive lipid lowering with atorvastatin vs usual care on clinical events in patients with a history of CHD

Patient characteristics

Patients with a history of CHD, defined as 1 of the following:

• Acute myocardial infarction (> 3 months before screening)
• Percutaneous transluminal coronary angioplasty (> 6 months before screening)
• Coronary artery bypass graft or unstable angina (> 3 months before screening)

Patient Number

24-42

Study Duration

Mean follow-up = 52 months

Study groups

• Atorvastatin (n = 1217) vs usual care (n = 1225)

• Atorvastatin dose was initiated at 10 mg and titrated up to 80 mg or until an LDL level of < 80 mg/dl was achieved

• Usual care was defined as the lipid treatment program prescribed by the patient's primary physician and could include diet, weight loss, physical activity, behaviour modification and antihyperlipidemic medication (including atorvastatin)

Primary endpoint

Composite endpoint of cardiac death, nonfatal MI, resuscitated cardiac arrest, revascularisation or unstable angina requiring hospitalization

Results

• Atorvastatin-treated patients showed a significantly greater reduction in LDL compared to usual care

• Statistically significant improvements in total cholesterol, HDL and triglycerides were seen in the atorvastatin group vs usual care group

• Primary endpoint (composite of cardiac death, nonfatal MI, resuscitated cardiac arrest, revascularization or unstable angina) was reduced by 17% in the atorvastatin group compared with patients who received usual care

• Atorvastatin therapy was associated with a 47% decrease in nonfatal MI vs usual care

• Mean dose in the study was 40.5 mg/day. Intensive lipid lowering with atorvastatin was well tolerated

Study Implications

“These results clearly show the important cardiovascular benefits of intensively lowering cholesterol with atorvastatin and the additional benefits that it provides for patients already receiving usual care.”

“This study provides new insights for physicians in how to effectively manage patients who have high cholesterol, especially those who have not succeeded in reaching their recommended cholesterol goal levels with usual care.”

Dr. Hunninghake, MD, University of Minnesota, Minneapolis

Presented at the American College of Cardiology Annual Scientific Session 2004

Back