Intensive lipid-lowering and CVD
Follow-up analysis of two of the most famous lipid-lowering trials confirms that intensive lipid-lowering therapy continues to be beneficial in the longer term. The PROVE IT-TIMI 22 (Pravastatin or Atorvastatin Evaluation and Infection Therapy-Thrombolysis in Myocardial Infarction 22) trial, first published in 2004, compared moderate lipid-lowering using standard-dose pravastatin to intensive lipid-lowering with high-dose atorvastatin after acute coronary syndrome. The study showed high-dose therapy significantly reduced the occurrence of death, myocardial infarction, stroke, and unstable angina requiring hospitalization or revascularization occurring more than 30 days after the event. The new post-hoc analysis (J Am Coll Cardiol 2009; 54:2358-2362) followed patients for up to 2 years and showed continued benefit in reduction of the primary endpoint (16%; P = 0 .005) with high-dose therapy, as well as reduction of additional events (19%; P = 0.009).
The IDEAL (Incremental Decrease in End Points Through Aggressive Lipid Lowering) study compared high-dose atorvastatin with usual dose simvastatin for the prevention of events subsequent to a first event. The study was published in 2005, and while not showing reduction in mortality in the 4.8 years of study, it did show a reduction in secondary cardiovascular outcomes with high-dose therapy. The new analysis looked at not only time to first event, but also second, third, fourth, and fifth events. High-dose therapy significantly reduced subsequent events by 17%-28%. The authors concluded that continued intensive statin therapy continues to be more effective than standard statin therapy, even beyond the first vascular event (J Am Coll Cardiol 2009;54:2353-2357).
Both these studies suggest that staying the course with intensive lipid-lowering in patients with cardiovascular disease is an effective long-term strategy.