Study confirms intensive lipid lowering is best
Intensive lowering of LDL-cholesterol reduces deaths and cardiovascular events in patients with acute coronary syndromes significantly more than moderate lipid lowering, according to a major study reported this week at the American College of Cardiology meeting held in New Orleans.
The PROVE-IT (pravastatin or atorvastatin evaluation and infection therapy)
study randomised 4,162 patients who had been admitted to hospital with
an acute myocardial infarction or unstable angina during the previous
10 days to standard lipid-lowering therapy (40mg pravastatin daily) or
more intensive treatment (80mg atorvastatin daily). Patients were also
randomised to the antibiotic gatifloxacin but results on this aspect
of the study have not yet been analysed.
Results showed a 16 per cent reduction in deaths and cardiovascular events
over two years in patients treated with intensive lipid lowering compared
with moderate reduction. Just over one-quarter (26.3 per cent) of patients
treated with pravastatin died or suffered a cardiovascular event compared
with 22.4 per cent of the intensively treated group (P=0.005).
The lead investigator in the study, Christopher Cannon, of Harvard Medical
School, Boston, suggested that the improved outcomes reflected effects
of treatment on low-density lipoprotein-cholesterol. Patients treated
with standard-dose pravastatin
had a median LDL-cholesterol level of 2.46mmol/L compared with 1.6mmol/L
in those treated with intensive lipid lowering therapy (P<0.001).
The study, which was sponsored by Bristol-Myers Squibb, manufacturer
of pravastatin, and Sankyo, manufacturer of gatifloxacin, is also published
online in The New England Journal of Medicine. |
The
Pharmaceutical Journal