Findings from the Atorvastatin vs Revascularization Treatments (AVERT) study showed patients with the fewest heart attacks had the greatest reduction in low-density lipoprotein cholesterol (LDL-C). Patients in the 18-month study ranged from age 30 to 78. Approximately 13% were older than age 70.
Researchers found that of 164 patients who received aggressive lipid lowering with atorvastatin, those with a 47% reduction in LDL-C had no cardiovascular events. But the LDL-C was reduced only 35% in others on the medication who suffered one or more event (e.g., nonfatal heart attack, worsening angina, need for bypass surgery, revascularization).
"The difference was significant, " reported W. Virgil Brown, MD, Professor of Medicine, Emory University School of Medicine. "The correlation was specific to LDL-C and no other lipids." Brown presented the AVERT data at the American College of Cardiology in New Orleans.
The report was an update of earlier findings from the AVERT trial - the first large study of systematic statin therapy as a possible alternative to angioplasty. Included were 341 patients with stable coronary artery disease (CAD) randomized to either 80 mg/d of atorvastatin or angioplasty.
All patients received standard medical therapy (e.g., aspirin, beta blockers, nitrates, calcium channel blockers, ACE inhibitors). The 130 patients who underwent percutaneous transluminal coronary angioplasty (PTCA) took various types and dosages of statins. Comparing the groups showed that the patients using atorvastatin:
* Experienced an overall 36% reduction in heart attacks, worsening angina, or other ischemic events.
* Had a significant delay in time to the first event.
Overall, the LDL-C was reduced from 149 to 119 mg/dL in the PTCA group compared to a reduction of 148 to 77 mg/dL in the statin group.
Brown attributes the contrast to strict guideline adherence in the atorvastatin group who maintained the 80 mg/day dose rigorously for 18 months.