JACC: Aggressive Lipitor reduces risk of MI, even for post-CABG patients

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Aggressive lipid-lowering with Lipitor 80 mg decreases major cardiovascular events and the need for repeat revascularization in patients with previous CABG, according to a post hoc analysis in May 20 issue of the Journal of the American College of Cardiology.

Sanjiv J. Shah, MD, from the division of cardiology at the San Francisco General Hospital and the department of medicine, University of California, San Francisco, and colleagues said the aim of the analysis from the TNT (Treating to New Targets) trial was to determine whether patients with previous CABG surgery achieved clinical benefit from intensive LDL-cholesterol lowering.

The study randomized a total of 10,001 patients with documented coronary disease, including 4,654 with previous CABG to atorvastatin 80 or 10 mg/day and followed them for a median of 4.9 years. The primary end point was the occurrence of a first major cardiovascular event (cardiac death, nonfatal MI, resuscitated cardiac arrest or stroke).

The researchers found the first major cardiovascular event occurred in 11.4 percent of the patients with prior CABG and 8.5 percent of those without prior CABG . In CABG patients, mean LDL-cholesterol levels at study end were 79 mg/dl in the 80-mg arm and 101 mg/dl in the 10-mg arm, and the primary event rate was 9.7 percent in the 80-mg arm and 13.0 percent in the 10-mg arm.

Repeat revascularization during follow-up, either CABG or percutaneous coronary intervention, was performed in 11.3 percent of the CABG patients in the 80-mg arm and 15.9 percent in the 10-mg arm, according to Shah and colleagues

As a result of their findings, the researchers concluded that intensive LDL-cholesterol lowering to a mean of 79 mg/dl with atorvastatin (Lipitor) 80 mg/day in patients with previous CABG reduces major cardiovascular events by 27 percent and the need for repeat coronary revascularization by 30 percent, compared with less intensive cholesterol-lowering to a mean of 101 mg/dl with Lipitor 10 mg/day.

Because this is an especially high-risk population that tends to be undertreated with lipid-lowering therapy, the authors noted that “this treatment should be the new standard of care, with the goal of reducing cardiovascular morbidity and mortality and prolonging bypass graft patency.”

Pfizer provided the funding for the study.