Update in Cardiology

Unstable Coronary Artery Syndromes

Intensive Atorvastatin Therapy Provided Greater Protection than Moderate Pravastatin Therapy for Patients Who Have Had an Acute Coronary Syndrome

Statins are known to reduce cardiac events after an acute coronary syndrome, but the optimal target level for the serum low-density lipoprotein (LDL) cholesterol reduction has been unknown. This study, known as the PROVE IT-TIMI 22 (Pravastatin or Atorvastatin Evaluation and Infection Therapy–Thrombolysis in Myocardial Infarction 22) study, was initiated to better determine that level. The investigators also wanted to find out whether statins had anti-inflammatory effects. They enrolled 4162 patients who had been hospitalized for an acute coronary syndrome within the past 10 days and randomly assigned them to receive 40 mg of pravastatin daily (standard therapy) or 80 mg of atorvastatin daily (intensive therapy). The primary end points were the composite of death from any cause, myocardial infarction, stroke, unstable angina requiring rehospitalization, and revascularization (performed within 30 days after randomization). The study was designed to establish the noninferiority of pravastatin compared with atorvastatin with respect to the time to an end point event.

Median serum LDL cholesterol level during treatment was 2.46 mmol/L (95 mg/dL) in the standard therapy group and 1.60 mmol/L (62 mg/dL) in the intensive therapy group (P < 0.001). Using Kaplan–Meier estimates, the investigators determined that the primary end point rate at 2 years was 26.3% in the standard therapy group and 22.4% in the intensive therapy group, reflecting a hazard ratio reduction of 16% (95% CI, 5% to 26%) in favor of atorvastatin (P = 0.005 ). The investigators then examined the magnitude of the benefit and …