Outcome of pitavastatin versus atorvastatin therapy in patients with hypercholesterolemia at high risk for atherosclerotic cardiovascular disease

Abstract

Background: There has been no report about outcome of pitavastatin versus atorvastatin therapy in high-risk patients with hypercholesterolemia. Methods: Hypercholesterolemic patients with one or more risk factors for atherosclerotic diseases (n = 664, age = 65, male = 54%, diabetes = 76%, primary prevention = 74%) were randomized to receive pitavastatin 2 mg/day (n = 332) or atorvastatin 10 mg/day (n = 332). Follow-up period was 240 weeks. The primary end point was a composite of cardiovascular death, sudden death of unknown origin, nonfatal myocardial infarction, nonfatal stroke, transient ischemic attack, or heart failure requiring hospitalization. The secondary end point was a composite of the primary end point plus clinically indicated coronary revascularization for stable angina. Results: The mean low-density lipoprotein cholesterol (LDL-C) level at baseline was 149 mg/dL. The mean LDL-C levels at 1 year were 95 mg/dL in the pitavastatin group and 94 mg/dL in the atorvastatin group. There were no differences in LDL-C levels between both groups, however, pitavastatin significantly reduced the risk of the primary end point, compared to atorvastatin (pitavastatin = 2.9% and atorvastatin = 8.1%, HR, 0.366; 95% CI 0.170-0.787; P = 0.01 by multivariate Cox regression) as well as the risk of the secondary end point (pitavastatin = 4.5% and atorvastatin = 12.9%, HR = 0.350; 95%CI = 0.189-0.645, P = 0.001). The results for the primary and secondary end points were consistent across several prespecified subgroups. There were no differences in incidence of adverse events between the statins. Conclusion: Pitavastatin therapy compared with atorvastatin more may prevent cardiovascular events in hypercholesterolemic patients with one or more risk factors for atherosclerotic diseases despite similar effects on LDL-C levels.

CAVI-Lowering Effect of Pitavastatin May Be Involved in the Prevention of Cardiovascular Disease: Subgroup Analysis of the TOHO-LIP

“…The design and results of the TOHO-LIP have been previously reported 13) . The TOHO-LIP was a randomized, controlled, open-label, parallel-grouped, multi-center clinical trial to examine the effect of pitavastatin compared with atorvastatin on cardiovascular events in patients with hypercholesterolemia who had one or more cardiovascular risk factors.…”

“…However, there is no randomized prospective study of pitavastatin in a 1-to-1 fashion to atorvastatin. Therefore, we conducted a multicenter, open-label, randomized controlled, head-to-head trial, the TOHO Lipid Intervention Trial Using Pitavastatin (TOHO-LIP), to compare the effects of pitavastatin with atorvastatin therapy for CV event prevention in patients with hypercholesterolemia at high risk of CVD 13) . The primary end point was a composite of CV death, sudden death of unknown origin, nonfatal myocardial infarction (MI), nonfatal stroke, transient ischemic attack, and heart failure requiring hospitalization.…”

“…The primary end point was a composite of CV death, sudden death of unknown origin, nonfatal MI, nonfatal stroke, transient ischemic attack, and heart failure requiring hospitalization. Details of the end point were previously described 13) . In this subgroup analysis, a composite of three-point major cardiac adverse events (3P-MACE: CV death, nonfatal MI, nonfatal stroke) was added as the secondary endpoint.…”

The Knowns and Unknowns of Contemporary Statin Therapy for Familial Hypercholesterolemia

“…This observation is consistent with current guideline recommendation that FH adults should be treated with the maximal tolerated dose of a high-intensity statin. In a recent study from Japan, pitavastatin (2 mg/day) compared with atorvastatin (10 mg/day) significantly reduced cardiovascular events in hypercholesterolemic patients [ 48 ]. However, the cardiovascular benefit of pitavastatin has not yet been specifically studied in FH.…”

<p>Synergistic Effect of Tangeretin and Atorvastatin for Colon Cancer Combination Therapy: Targeted Delivery of These Dual Drugs Using RGD Peptide Decorated Nanocarriers</p>

“…17 Atorvastatin (ATST) is a synthetic statin commonly used in the treatment of hypercholesterolemia. 18 ATST was also reported as having the ability to modulate cell apoptosis, thus influencing a wide range of diseases including cancer. 19 Accumulating studies have shown that a combination of ATST with different agents produced enhanced anti-cancer effects against various cancers, including colon, lung, and prostate cancer.…”