Moderate Statin Therapy May Be Right Treatment For Some
By Paula Rasich
Reviewed by Elizabeth Klodas, MD, FACC
(CardioSmart) A new study suggests that heart attack sufferers treated with a moderate cholesterol-lowering statin, instead of the standard intensive therapy, may get the same benefits---if their “bad” LDL cholesterol is already within lower limits.
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In a new analysis of the PROVE-IT-TIMI 22 (Pravastatin or Atorvastatin Evaluation and Infection Therapy—Thrombolysis In Myocardial Infarction 22) Trial, Robert P. Giugliano, MD, and colleagues from Brigham and Women’s Hospital and Harvard Medical School, both in Boston, examined data on 2,986 patients admitted to the hospital for heart attack or unstable angina (chest pain). Of those, half were randomized to receive intensive statin therapy (80 mg atorvastatin or Lipitor) and half got less intensive statin therapy (40 mg pravastatin or Pravachol) soon after being hospitalized. On average, patients were followed for two years.In this investigation, researchers found that intensive therapy lowered LDL levels and reduced cardiovascular risk, but more so in patients who started out with the highest LDL levels. The findings revealed that those with LDL levels above 132 mg/dL treated with high-dose statins were 37% less likely to have a stroke, recurrent heart problems or die than those treated with less intensive statin therapy.
In contrast, patients with low baseline levels of LDL treated with intensive statin therapy experienced similar outcomes as those treated with the less intensive dose. Experts haven’t yet determined the cutoff point for high versus low-dose statin therapy, but this analysis showed that the odds of cardiovascular complications were the same with either treatment approach if the starting LDL is already < 70.
“Our study suggests that patients with low LDL hospitalized for an acute coronary syndrome might not need intensive statin therapy,” says Dr. Giugliano. “That’s the hypothesis generated from these data, but we need to test it in future studies.”
If you’re high risk---meaning you’ve had a stroke or heart attack, have diabetes, known coronary or vascular disease, or have high cholesterol and two other classic risk factors---current guidelines recommend getting your LDL cholesterol to 70 or lower. “Our study is supportive of the current target of less than 70 in high risk patients,” says Dr. Giugliano.
The study findings are published in the September 9, 2008 issue of the Journal of the American College of Cardiology.
Sources:
Giraldez RR et al. Baseline Low-Density Lipoprotein Cholesterol Is an Important Predictor of the Benefit of Intensive Lipid-Lowering Therapy. A PROVE IT-TIMI 22 (Pravastatin or Atorvastatin Evaluation and Infection Therapy---Thrombolysis In Myocardial Infarction 22) Analysis. Journal of the American College of Cardiology, 2008.
Robert P. Guigliano, MD, Associate Physician in Cardiovascular Medicine at the Brigham and Women’s Hospital and Assistant Professor of Medicine at Harvard Medical School.
