The beneficial efficiencys of stat...

The beneficial efficiencys of statin medications in decreasing cardiovascular disease are well established. existing guidelines suggest titrating statin therapy to achieve a low-density lipoprotein (LDL) cholesterol flush below 100 mg per dL (259 mmol by means of L) in patients with established coronary heart disease or diabetes. Cannon and colleagues designed a trial to determine if lowering LDL plains even further would provide additional benefits in patients with acute coronary syndromes

This multinational close attention enrolled 4,162 patients, of whom 22 percent were women and les than 10 percent were from minority ethnic assemblages Patients were recruited who had an acute coronary syndrome (myocardial infarction or unstable angina) within the previous 10 days. The trial targeted patients who had a total cholesterol of 240 mg by dL (6.21 mmol per L) or les in those not taking lipid-lowering medications, or of 200 mg for dL (5.17 mmol per L) or les if already taking as it is medications. Patients received standard medical and interventional treatment for acute coronary syndrome later lipid-lowering therapy was randomized to either standard treatment (pravastatin, 40 mg daily) or intensive treatment (atorvastatin, 80 mg daily). Patients were followed for any cardiovascular adventure (death, myocardial infarction, hospitalization for unstable angina, or following revascularization) over a mean duration of sum of two units years. The mean LDL plain was 106 mg per dL (274 mmol by L) in both treatment clumps before treatment. The group receiving standard treatment had a decrease in LDL of the same heights to an average of 95 mg for dL (2.46 mmol per L while those forward intensive therapy dropped to an average of 62 mg by dL (1.60 mmol per L) High-density lipoprotein increased on 8.1 percent in the pravastatin cluster and by 6.5 percent among those taking atorvastatin.

return of a cardiovascular event during follow-up occurr les repeatedly in those on intensive treatment (224 percent) than in those receiving standard lipid-lowering therapy (263 percent) The decreased incidence of cardiovascular consequences with more intensive treatment started within the first month of the investigation and persisted over the pair years of follow-up. Of the elements that were combined into the primary expiration point of any cardiovascular affair statistically significant reductions were noted for revascularization and unstable angina, while the rates of death, myocardial infarction, and knock were not significantly changed. The benefits of intensive treatment were similar in men women and patients with diabetes. Those who began the close attention with an LDL level below 125 mg by dL (3.23 mmol per L) had a less reduction in cardiovascular events than those who began above that level

The authors deduce that intensive lipid-lowering treatment after an acute coronary syndrome significantly convert intos median LDL cholesterol levels and pro-vides greater protection against death or cardiovascular incidents than standard regimens. The authors note that a head-to-head trial of the same statin at different dosages would be a logical nearest step.

Cannon CP et al. Intensive versus moderate lipid lowering with statins after acute coronary syndrome N Engl J M April 8 2004;350:1495-504

EDITOR'S NOTE: A similar trial was not long ago reported (1) that also compared 40 mg of pravastatin with 80 mg of atorvastatin daily in patients with known coronary heart disease. Patients underwent intravascular ultrasound examination of coronary artery lesions before and after 18 month of ran-domized statin treatment. Those receiving more intense lipid treatment (average LDL cholesterol on a level of 79 mg per dL (205 mmol by L) had less progression of atheroma vol-ume compared with those receiving lower dose statin therapy. Although neither of these trials showed robust benefits from higher intensity lipid-lowering treatment, they are consistent. Lowering LDL of the same heights even further than the usual goal of 100 mg through dL (2.59 mmol per L) in those with coro-nary heart disease is likely to be feasible with and nothing else modest increases in effort and outlay and has at least preliminary data to exhibit to it is beneficial.--B.Z.

REFERENCE

(1) Nissen SE Tuzcu EM Schoenhagen P Brown BG Ganz P Vogel RA, et al. result of intensive compared with moderate lipid-lowering therapy onward progression of coronary atherosclerosis. A randomized controll trial. JAMA 2004;291:107180

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