Relative efficacy of atorvastatin 80 mg and pravastatin 40 mg in achieving the dual goals of low-density lipoprotein cholesterol <70 mg/dl and C-reactive protein <2 mg/l: an analysis of the PROVE-IT TIMI-22 trial.
Level 2 - randomized trial
Secondary analysis of an individual randomized controlled trial
PubMed 15893181 · doi:10.1016/j.jacc.2005.02.080
What was done
A secondary analysis of the randomized PROVE-IT TIMI-22 trial evaluated the relative efficacy of atorvastatin 80 mg daily versus pravastatin 40 mg daily in achieving dual targets of low-density lipoprotein cholesterol (LDL-C <70 mg/dl) and C-reactive protein (CRP <2 mg/l) among 3,745 acute coronary syndrome patients. Risk of recurrent myocardial infarction or vascular death was assessed with multivariable adjustment for age, gender, smoking, diabetes, hypertension, obesity, and HDL-C.
What was found
A total of 1,018 of 3,745 participants (27.1%) achieved the dual goals. Patients reaching LDL-C <70 mg/dl and CRP <2 mg/l had a 28% lower risk of recurrent myocardial infarction or vascular death (relative risk = 0.72; 95% CI 0.52 to 0.99). Of those achieving dual goals, 80.6% were on atorvastatin 80 mg and 19.4% were on pravastatin 40 mg (p < 0.001). Goal attainment for LDL-C <70 mg/dl and CRP <2 mg/l was 44% with atorvastatin versus 11% with pravastatin; for LDL-C <70 mg/dl and CRP <1 mg/l, it was 26.1% versus 5.8%. Correlation between 30-day and study-end levels was r = 0.61 for CRP and r = 0.62 for LDL-C (both p < 0.001).
Why it matters
Intensive statin therapy (atorvastatin 80 mg) achieves combined lipid and inflammatory targets far more frequently than moderate statin therapy (pravastatin 40 mg), which correlates with reduced cardiovascular events. Even with high-dose therapy, however, the majority of patients did not reach optimal biomarker targets.
Limits
This is a secondary, on-treatment analysis of an RCT cohort; achieving biomarker targets was not randomly assigned and may reflect unmeasured biological confounding. The abstract does not report adverse events, adherence rates, or total mortality.
Cited by
- contradicts Research by Paul Ridker and colleagues demonstrated that low doses of statins are as effective at reducing inflammation as higher doses.