Murphy SA ， Cannon CP ， Wiviott SD ， McCabe CH ， Braunwald E .
TIMI Study Group， Cardiovascular Division， Department of Medicine， Brigham and Women’s Hospital and Harvard Medical School， Boston， Massachusetts， USA.
Comment in:
J Am Coll Cardiol. 2009 Dec 15;54(25):2363-5.
AbstractOBJECTIVES: In addition to reducing first events in patients after an acute coronary syndrome (ACS)， we hypothesized that high-dose atorvastatin 80 mg would also reduce recurrent cardiovascular events， and therefore total events， compared with pravastatin 40 mg during the 2-year follow-up.
BACKGROUND: In the PROVE IT-TIMI 22 (Pravastatin or Atorvastatin Evaluation and Infection Therapy-Thrombolysis In Myocardial Infarction 22) trial， more intensive lipid lowering with high-dose atorvastatin reduced the first occurrence of the primary end point (death， myocardial infarction， unstable angina requiring rehospitalization， stroke， or revascularization > or = 30 days) compared with moderate lipid lowering with pravastatin.
METHODS: Poisson regression analysis was performed to compare the number of occurrences of the primary end point between high-dose atorvastatin and pravastatin in the PROVE IT-TIMI 22 trial.
RESULTS: As previously reported， first primary end point events were reduced by 16% with atorvastatin 80 mg versus pravastatin 40 mg (n = 464 vs. n = 537， respectively; p = 0.005). Additional events were also reduced by 19% with atorvastatin 80 mg (n = 275 vs. n = 340， respectively; p = 0.009). Overall， there were 138 fewer primary efficacy events with atorvastatin 80 mg versus pravastatin 40 mg (n = 739 vs. n = 877， respectively; rate ratio: 0.85， 95% confidence interval: 0.77 to 0.94， p = 0.001).
CONCLUSIONS: Although analytic techniques commonly used in clinical outcomes trials censor patients who experience a component of the primary composite end point， total cardiovascular events are important to patients， clinicians， and health care payers. Maintaining low levels of low-density lipoprotein cholesterol is central to preventing additional atherosclerotic development and subsequent cardiovascular events. Atorvastatin 80 mg， a more intensive low-density lipoprotein cholesterol lowering agent， reduced both first and subsequent primary end point events compared with pravastatin 40 mg after ACS.