CLINICAL RESEARCH: TREATMENT OF HYPERLIPIDEMIA
Relative Efficacy of Atorvastatin 80 mg and Pravastatin 40 mg in Achieving the Dual Goals of Low-Density Lipoprotein Cholesterol <70 mg/dl and C-Reactive Protein <2 mg/l
An Analysis of the PROVE-IT TIMI-22 Trial
Paul M. Ridker, MD*, ,*,
David A. Morrow, MD, ,
Lynda M. Rose, MS*,,
Nader Rifai, PhD*,,
Christopher P. Cannon, MD and
Eugene Braunwald, MD
* Center for Cardiovascular Disease Prevention, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
The Donald W. Reynolds Center for Cardiovascular Research, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
The Thrombolysis In Myocardial Infarction (TIMI) Study Group, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts.
Manuscript received January 23, 2005;
revised manuscript received February 15, 2005,
accepted February 22, 2005.
* Reprint requests and correspondence: Dr. Paul M. Ridker, Center for Cardiovascular Disease Prevention, Brigham and Women’s Hospital, 900 Commonwealth Avenue East, Boston, Massachusetts 02215. (Email: pridker{at}partners.org).
OBJECTIVES: The aim of this research was to compare relative efficacy of different statin regimens in achieving the dual goals of low-density lipoprotein cholesterol (LDL-C) and C-reactive protein (CRP) reduction.
BACKGROUND: While secondary prevention guidelines for statin therapy suggest lowering LDL-C levels <70 mg/dl, we have recently shown that clinical outcomes are improved when CRP levels are also lowered <2 mg/l.
METHODS: We addressed the relative efficacy of pravastatin 40 mg and atorvastatin 80 mg daily to reduce LDL-C and CRP among 3,745 acute coronary syndrome patients.
RESULTS: A total of 1,018 participants (27.1%) achieved the dual goals of LDL-C <70 mg/dl and CRP <2 mg/l. After adjustment for age, gender, smoking, diabetes, hypertension, obesity, and HDL-C, these individuals had a 28% lower risk of recurrent myocardial infarction or vascular death (relative risk = 0.72; 95% confidence interval 0.52 to 0.99). Of those who achieved dual goals, 80.6% received atorvastatin 80 mg, while 19.4% received pravastatin 40 mg (p < 0.001). Only 11% allocated pravastatin and 44% allocated atorvastatin achieved the goals of LDL-C <70 mg/dl and CRP <2 mg/l, and only 5.8% allocated pravastatin 40 mg and 26.1% allocated atorvastatin 80 mg reached the even lower goals of LDL-C <70 mg/dl and CRP <1 mg/l. The correlation coefficient for CRP measured at 30 days and at end of study was 0.61 (p < 0.001), a value almost identical to that for LDL-C over the same follow-up period (r = 0.62, p < 0.001).
CONCLUSIONS: While atorvastatin 80 mg was superior to pravastatin 40 mg in terms of achieving the dual goals of aggressive LDL-C and CRP reduction, neither agent brought the majority of patients below thresholds needed to maximize patient benefit.
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Abbreviations and Acronyms
| | CRP = C-reactive protein | | HDL-C = high-density lipoprotein cholesterol | | hsCRP = high-sensitivity C-reactive protein | | LDL-C = low-density lipoprotein cholesterol | | PROVE-IT = Pravastatin or Atorvastatin Evaluation and Infection trial | | TIMI = Thrombolysis In Myocardial Infarction |
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