Treatment with Atorvastatin to the National Cholesterol Educational Program Goal Versus 'Usual' Care in Secondary Coronary Heart Disease Prevention

Athyros, Vasilios G.; Papageorgiou, Athanasios A.; Mercouris, Bodosakis R.; Athyrou, Valasia V.; Symeonidis, Athanasios; Basayannis, Elias; Demitriadis, Dimokritos S.; Kontopoulos, Athanasios G.

doi:10.1185/030079902125000787

Cited by 471 publications

(207 citation statements)

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“…We determined the target dose by referring to the cholesterollowering equivalent dose 21,36 as well as the dose tested in the largescale RCTs of each statin for long-term cardiovascular prevention. 1,2,5,8,[37][38][39][40] The target dose was set as 10 mg for atorvastatin and 40 mg for the other statins. The binary variable "at or above target dose" was subsequently adjusted in the Cox model.…”

Section: Methodsmentioning

confidence: 99%

“…[1][2][3][4][5][6][7][8] Although these trials have significantly influenced post-AMI treatment, [9][10][11][12] it remains unclear whether all statins are equally effective in preventing recurrent AMI and death. Drugs in the same class are generally thought to be therapeutically equivalent because of similar mechanisms of action (class effect).…”

Section: Researchmentioning

confidence: 99%

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Effectiveness of statins for secondary prevention in elderly patients after acute myocardial infarction: an evaluation of class effect

Zhou

Rahme²,

Abrahamowicz³

et al. 2005

Canadian Medical Association Journal

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ResearchRecherche R andomized controlled trials (RCTs) have shown that the use of statins after acute myocardial infarction (AMI) are effective in reducing the incidence of both fatal and nonfatal cardiovascular events. [1][2][3][4][5][6][7][8] Although these trials have significantly influenced post-AMI treatment, [9][10][11][12] it remains unclear whether all statins are equally effective in preventing recurrent AMI and death. Drugs in the same class are generally thought to be therapeutically equivalent because of similar mechanisms of action (class effect). [13][14][15] However, in the absence of comparative data, this assumption requires evaluation. Statins differ in multiple characteristics, including liver and renal metabolism, half-life, effect on other serum lipid components, bioavailability and potency. [16][17][18][19] These differences could potentially influence the extent to which the drugs are beneficial. Despite limited evidence in support of a differential benefit of statins for secondary prevention, preferential prescribing already occurs in practice and cannot be fully explained by the existing evidence or guidelines. 20 Comparative data of statins are thus required to inform health care decision-making.A number of RCTs have directly compared statins using surrogate end points, such as lipid reduction, 21-23 markers of hemostasis and inflammation [24][25][26] or reduction in number of atherotic plaques. 27 However, the extent to which these results can be extrapolated to clinically relevant outcomes remains to be established. The newly released PROVE IT-TIMI 22 trial 28 was the first trial to compare 2 statins for cardiovascular prevention. The study showed that atorvastatin used at a maximal dose of 80 mg (intensive therapy) was better than pravastatin at a dose of 40 mg (standard therapy) in decreasing the incidence of cardiovascular events and procedures. The study was, however, conducted to show the benefit associated with increased treatment intensity. It did not compare the drugs by milligramequivalent doses or by cholesterol-lowering equivalent doses. Moreover, no difference was detected when death alone or the combined outcome of death or AMI was evaluated. Other than the PROVE IT-TIMI 22 trial, few data are currently available from RCTs that compare statins for cardiovascular prevention. 29 We conducted a population-based study to examine the relative effectiveness of different statins for long-term secondary prevention after AMI. We used retrospective cohorts of elderly patients prescribed statins after AMI in 3 provinces. Five statins were studied: atorvastatin, pravastatin, simvastatin, lovastatin and fluvastatin. The newest statin, rosuvastatin, was not available during the study period and was not considered in this study. acute myocardial infarction (AMI). However, it is unclear whether different statins exert a similar effect in reducing the incidence of recurrent AMI and death when used in clinical practice. Methods: We conducted a retrospective cohort study (1997)(1998)(1999)...

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Section: Methodsmentioning

confidence: 99%

Section: Researchmentioning

confidence: 99%

Effectiveness of statins for secondary prevention in elderly patients after acute myocardial infarction: an evaluation of class effect

Zhou

Rahme²,

Abrahamowicz³

et al. 2005

Canadian Medical Association Journal

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“…18 In the LIPID study, 19 the relative risk reduction was 24% in all patients and 19% in patients with DM, whereas 51% of all patients and 58% of diabetic patients had relative risk reduction in the GREACE study. 20 In the present study, patients with DM displayed better improvement over time than patients without DM. This could potentially be due to enhanced therapeutic goals among diabetic patients, enhanced monitoring of diabetic patients and enhanced care treatment with care management, or a combination of factors.…”

Section: Discussionmentioning

confidence: 51%

Impact of predictors upon the reduction of lipid parameters in family medicine practice

et al. 2015

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CONTEXT AND OBJECTIVE: To evaluate predictors of changes in lipid parameters consisting of LDL-C (low-density lipoprotein cholesterol), TC (total cholesterol) and non-HDL-C (non-high density lipoprotein cholesterol) among primary care patients. DESIGN AND SETTING: Retrospective study conducted on family medicine patients. METHODS: Demographic features and other clinically relevant information were abstracted from medical records. The primary outcome was the difference in LDL-C level from initial testing to the index test. Secondary outcomes were the changes in TC and non-HDL-C levels between two measurements. RESULTS: Three hundred and eleven participants were included in the final secondary analysis. Multiple linear regression revealed that male patients (β = 4.97, P = 0.040), diabetes (β = 9.75, P = 0.003) and higher LDL-C levels at baseline (β = 0.35, P < 0.001) were positively associated with LDL variance, whereas longer time period (β = -0.15, P = 0.045) and familial hypercholesterolemia history (β = -7.56, P = 0.033) were negatively associated. Male patients (β = 8.45, P = 0.002), DM (β = 9.26, P = 0.011), higher TC levels at baseline (β = 0.35, P < 0.001) and taking statins (β = 7.31, P = 0.023) were positively associated with TC variance, whilst longer time period (β = -0.183, P = 0.031) and familial hypercholesterolemia (β = -10.70, P = 0.008) were negatively associated. CONCLUSION: In the present study, patients who were male, on statin treatment, diagnosed with diabetes and had higher baseline lipid values were more likely associated with better lipid outcomes at future testing.RESUMO CONTEXTO E OBJETIVO: Avaliar preditores de alterações nos parâmetros lipídicos que consistem em LDL-C (colesterol de lipoproteína de baixa densidade), TC (colesterol total) e não HDL-C (não colesterol de lipoproteína de alta densidade) entre os pacientes de cuidados primários. TIPO DE ESTUDO E LOCAL: Estudo retrospectivo realizado em pacientes de medicina familiar. MÉTODOS: Aspectos demográficos e outras informações clinicamente relevantes foram extraídos dos prontuários médicos. O desfecho primário foi a diferença de nível de LDL-C entre os exames iniciais e o exame índice. Os desfechos secundários foram as mudanças dos níveis de TC e não HDL-C entre as duas medidas. RESULTADOS: Trezentos e onze participantes foram incluídos na análise secundária final. Regressão linear múltipla revelou que os pacientes do sexo masculino (β = 4,97, P = 0,040), diabetes (DM) (β = 9,75, P = 0,003) e níveis de LDL mais elevados no início do estudo (β = 0,35, P < 0,001) foram associados positivamente com variância LDL, enquanto longo período de tempo (β = -0,15, P = 0,045) e história hipercolesterolemia familiar (β = -7,56, P = 0,033) foram associados negativamente. Pacientes do sexo masculino (β = 8,45, P = 0,002), com DM (β = 9,26, P = 0,011), níveis elevados de CT na linha de base (β = 0,35, P < 0,001) e tomar estatinas (β = 7,31, P = 0,023) associaram-se positivamente com a variância TC, enquanto longo período de tempo (β = -0,1...

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“…These measures of treatment effect can be calculated using the three year risk of a cardiovascular event with and without statin therapy (Fig. 5 ) [19]. The results can be compared to the five year risk of developing glaucoma with and without treatment in the Ocular Hypertension Treatment Study (Fig.…”

Section: Iop As a Risk Factormentioning

confidence: 99%

Intraocular Pressure: Does it Measure Up?

Wilson

Singh²

2009

TOOPHTJ

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The relationship between intraocular pressure (IOP) and glaucoma is complex and not fully understood. We question the validity of several claims relating to the IOP-glaucoma relationship: (1) that 12 mm Hg is an important target in IOP control; (2) that IOP variability is an important risk factor for glaucoma progression; and (3) that every millimeter of mercury of IOP lowering reduces the risk of glaucoma progression by some specific percentage amount. Further, IOP is generally accepted to be an important – if not most important – risk factor for glaucoma development and progression. Using measures of treatment effect – absolute risk reduction, relative risk, and relative risk reduction – we compare the strength of IOP as a risk factor to the strength of a cardiac risk factor in cardiovascular disease.

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Treatment with Atorvastatin to the National Cholesterol Educational Program Goal Versus 'Usual' Care in Secondary Coronary Heart Disease Prevention

Abstract: Long-term treatment of CHD patients with atorvastatin to achieve NCEP lipid targets significantly reduces total and coronary mortality, coronary morbidity and stroke, in comparison to patients receiving 'usual' medical care. Treatment with atorvastatin is well tolerated and cost-effective.

Cited by 471 publications

References 24 publications

Effectiveness of statins for secondary prevention in elderly patients after acute myocardial infarction: an evaluation of class effect

Effectiveness of statins for secondary prevention in elderly patients after acute myocardial infarction: an evaluation of class effect

Impact of predictors upon the reduction of lipid parameters in family medicine practice

Intraocular Pressure: Does it Measure Up?

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