Therefore, the use of atorvastatin 80 mg among patients with coronary artery disease (CAD) had resulted in a risk reduction of 16–22% in major adverse CV event. 9 Similarly, in the Effects of Atorvastatin on Early Recurrent Ischemic Events in Acute Coronary Syndrome (MIRACL) trial, the early use of atorvastatin 80 mg after ACS compared to placebo had resulted in a 16% significant reduction in a primary composite outcome of mortality, nonfatal myocardial infarction, and cardiac arrest with resuscitation over a follow-up period of 16 weeks. 8 Additionally, the Intensive Lipid Lowering with Atorvastatin in Patients with Stable Coronary Disease (TNT) trial, which compared atorvastatin 80 mg to 10 mg, showed a risk reduction of 22% over 4.9 years in a major adverse CV event, defined as CV death, nonfatal myocardial infarction, resuscitation after cardiac arrest and fatal or nonfatal stroke. 8- 10 The Intensive vs Moderate Lipid Lowering with Statins after Acute Coronary Syndromes (PROVE IT) trial, which compared atorvastatin 80 mg to pravastatin 40 mg, demonstrated a risk reduction of 16% over 2 years in the composite endpoint of all-cause mortality, myocardial infarction, documented unstable angina requiring re-hospitalization, revascularization (performed at least 30 days after randomization), and stroke among patients with the acute coronary syndrome (ACS). 3- 10 Specifically, large randomized controlled clinical trials have established the efficacy and safety of statins for secondary prevention of CVDs. 1, 2 Several clinical trials have demonstrated that statin use reduces major CV events. However, clinicians might favor the use of atorvastatin 40 mg over 80 mg as an initial high-intensity statin therapy if they have concerns about safety.Ī high-intensity statin, defined as atorvastatin 40 or 80 mg and rosuvastatin 20 or 40 mg orally, which lowers low-density lipoprotein cholesterol (LDL-C) by ≥50%, is recommended by clinical practice guidelines for secondary prevention of cardiovascular (CV) events among patients who have an atherosclerotic CV disease (CVD Class 1A).Clinicians may use either high-intensity atorvastatin dose following ACS.The 2 high-intensity doses of atorvastatin resulted in similar safety outcomes.The use of 2 high-intensity doses of atorvastatin (40 and 80 mg) post-ACS was associated with similar cardiovascular outcomes at 1 and 12 months postdischarge.The use of atorvastatin 40 mg in comparison to atorvastatin 80 mg in patients with ACS resulted in similar cardiovascular effectiveness and safety outcomes. Similarly, the use of the 2 doses of atorvastatin resulted in comparable safety outcomes, including liver toxicity, myopathy and rhabdomyolysis with an event rate of <1% in both groups. The incidence of the primary effectiveness outcome did not differ between the atorvastatin 40-and 80-mg groups at 1 month (0.8 vs 1.3% adjusted hazard ratio = 0.59, 95% confidence interval 0.04–8.13, P =. Most of the patients were Asian (73%), male (97%) with a mean age of 50 years and presented with ST-elevation myocardial infarction (60%). Of the 626 patients included in the analyses, 475 (75.9%) received atorvastatin 40 mg, while 151 (24.1%) received atorvastatin 80 mg following ACS. Cox proportional hazard regression analysis was used to determine the association between the 2 high-intensity atorvastatin dosing regimens and the primary outcome at 1 month and 12 months postdischarge. The primary endpoint was a composite of cardiovascular disease-associated death, nonfatal ACS and nonfatal stroke. This retrospective observational cohort study using real-world data included patients admitted with ACS to the Heart Hospital in Qatar between 1 January 2017 and 31 December 2018.
To compare the effectiveness and safety of 2 high-intensity atorvastatin doses (40 mg vs 80 mg) among acute coronary syndrome (ACS) patients.