Atorvastatin
More Effective Than Pravastatin for Atherosclerosis
Atorvastatin
80 mg/day lowered low-density lipoprotein (LDL) cholesterol levels
further than did pravastatin 40 mg/day, and it also reversed
atherosclerosis as reflected by reduced carotid intima-media thickness
(CIMT).
That,
according to results of a head-to-head trial published online Sept. 23
in Circulation.
"This
is the first comparison of two statin drugs in a general population
that looked at more than their cholesterol-lowering abilities,"
lead author Allen J. Taylor, MD, director of cardiovascular research
at Walter Reed Army Medical Center in Washington, D.C., says in a news
release. "Previous studies found that patients in whom plaque
stabilized — or stopped progressing — had the lowest risk of heart
attacks and other cardiovascular disease problems. In general, past
studies have shown that regression [of plaque] is uncommon."
This
single-center, randomized clinical trial followed 161 patients who met
National Cholesterol Education Program (NCEP) II criteria for
lipid-lowering therapy. Mean age was 60 years, 71.4% were male, and
46% had known cardiovascular disease. Baseline CIMT and other clinical
characteristics were similar in both groups.
After
12 months of treatment, LDL cholesterol levels were 76 +/- 23 mg/dL in
the atorvastatin group (-48.5%) and 110 +/- 30 mg/dL in the
pravastatin group (-27.2%; P<.001). Blinded, serial
ultrasound of the far wall of the distal common carotid artery
revealed progressive CIMT regression in the atorvastatin group (change
in CIMT, -0.038 +/- 0.021 mm) and stable CIMT in the pravastatin group
(change, 0.026 +/- 0.017 mm; P=.03). CIMT decreased in 54% of
atorvastatin-treated patients and in 39% of pravastatin-treated
patients.
"We
need to carefully define at what point lower LDL values have the
greatest benefit in lowering the risk of heart disease," Taylor
says. "This study would suggest that LDL values much lower than
100 mg/dL appears better than a value of around 100."
In
an accompanying editorial, Prediman K. Shah, MD, from Cedars Sinai
Medical Center in Los Angeles, California, notes that several
large-scale trials are underway to compare the effect of moderate
versus aggressive cholesterol lowering on coronary plaque and cardiac
events.
"The
data provided by Taylor are of potential interest and could have
significant implications for clinical practice," he writes.
"However, before we conclude that more LDL-lowering means less
atherosclerosis progression or clinical events, more in depth research
is necessary." Circulation.
Published online Sept. 23, 2002.
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