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

• Published in: Journal of the American College of Cardiology Vol. 45; no. 10; pp. 1644 - 1648
• Main Authors: RIDKER, Paul M, MORROW, David A, ROSE, Lynda M, RIFAI, Nader, CANNON, Christopher P, BRAUNWALD, Eugene
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Science 17.05.2005; Elsevier Limited
• Subjects: Administration, Oral; Aged; Anticholesteremic Agents - administration & dosage; Atorvastatin Calcium; Biological and medical sciences; C-Reactive Protein - metabolism; Cardiology; Cardiology. Vascular system; Cholesterol; Cholesterol, LDL - blood; Cohort Studies; Coronary Restenosis - blood; Coronary Restenosis - drug therapy; Coronary Restenosis - mortality; Dose-Response Relationship, Drug; Drug therapy; Female; Fluoroquinolones - administration & dosage; Follow-Up Studies; Heart attacks; Heptanoic Acids - administration & dosage; Humans; Hypercholesterolemia - blood; Hypercholesterolemia - drug therapy; Hypercholesterolemia - mortality; Male; Medical sciences; Middle Aged; Myocardial Infarction - blood; Myocardial Infarction - drug therapy; Myocardial Infarction - mortality; Pravastatin - administration & dosage; Pyrroles - administration & dosage; Secondary Prevention; Statins; Statistics as Topic; Survival Rate; Treatment Outcome; Lipoprotein LDL; Efficiency; Analysis; Atorvastatin; Circulatory system; Cardiology; Pravastatin; C reactive protein; Phlebology; Cholesterol
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/j.jacc.2005.02.080

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. 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. 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. 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). 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.