By Sara Freeman
ISTANBUL, Turkey -- May 2, 2008 -- Patients who are treated with an 80-mg rather than a 10-mg dose of atorvastatin after surgery or stenting for coronary heart disease (CHD) are less likely to experience a subsequent cardiovascular (CV) event, according to a post hoc analysis presented here at the 77th Congress of the European Atherosclerosis Society (EAS 2008).
These findings, from a post hoc analysis of the Treating to New Targets (TNT) study, added further support to the concept of "lower is better" when it comes to targeting low-density lipoprotein cholesterol (LDL-C).
David Waters, MD, Chief, Division of Cardiology, San Francisco General Hospital, and Professor of Medicine in Residence, University of California, San Francisco, California, presented the findings in a poster presentation on April 28.
In the original TNT study, patients with CHD who underwent intensive LDL-C lowering to a level of 2.0 mmol/L (77 mg/dL) with atorvastatin 80 mg/day achieved additional clinical benefit beyond that seen in patients who achieved LDL-C reductions to 2.6 mmol/L (101 mg/dL) with atorvastatin 10 mg/day (LaRosa JC et al. Am J Cardiol. 2004;93:154-158).
Dr. Waters and colleagues conducted their post hoc analysis to see if there was any benefit of using an aggressive lipid-lowering approach after percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG), or a combination of the 2 procedures.
Of the 10,001 patients in the TNT study, a total of 3,951 patients had undergone PCI, 3,198 had CABG, and 1,456 had undergone both procedures before entering the TNT study.
After a median follow-up of 4.9 years, significantly fewer patients treated with the higher-dose of statin experienced a first major CV event (CHD death, nonfatal myocardial infarction [MI], resuscitated cardiac arrest, or stroke) compared with those who received the lower dose.
Among patients in the PCI group, 8.6% of those given atorvastatin 80 mg had a major CV event versus 10.6% of those who received the 10-mg dose (P = .008). This represented an absolute risk reduction of 2.1%.
In patients who had undergone CABG, the incidence of a major CV event was 9.7% in the high-dose group and 13.5% in the low-dose group (P = .0004). This represented an absolute risk reduction of 3.8%.
It is important to note that the incidence of repeat revascularisation was also significantly reduced among patients in the CABG group (P < .0001) and the PCI group (P < .0001).
Dr. Waters and colleagues concluded that the incidence of major CV events was significantly higher among the patients who had undergone CABG before being enrolled in the TNT study compared with those who had undergone PCI.
While CABG and PCI both were associated with a high risk of major CV events, patients who had undergone CABG were in particular danger of experiencing a subsequent event. However, intensive lipid lowering with the 80-mg dose of atorvastatin was able to reduce significantly the rate of primary CV events in both CABG and PCI patients compared with the 10-mg dose.
"In all patients with previous revascularisation, LDL-C should be lowered aggressively to reduce CV events," the researchers advised.
Funding for the TNT study was provided by Pfizer.
[Presentation title: Effect of Intensive Cholesterol Lowering With Atorvastatin 80 mg in Patients With Previous Revascularization: A Treating to New Targets (TNT) Substudy. Abstract PO48-738]
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