Outcomes of using high- or low-dose atorvastatin in patients 65 years of age or older with stable coronary heart disease.
BACKGROUND
Increased life expectancy is associated with an increase in the burden of chronic cardiovascular disease.


OBJECTIVE
To assess the efficacy and safety of high-dose atorvastatin in patients 65 years of age or older.


METHODS
A prespecified secondary analysis of the Treating to New Targets study, a randomized, double-blind clinical trial.


METHODS
256 sites in 14 countries participating in the Treating to New Targets study.


METHODS
10,001 patients (3809 patients > or =65 years of age) with coronary heart disease (CHD) and low-density lipoprotein cholesterol levels less than 3.4 mmol/L (<130 mg/dL).


METHODS
Patients were randomly assigned to receive atorvastatin, 10 or 80 mg/d.


METHODS
The primary end point was the occurrence of a first major cardiovascular event (death from CHD, nonfatal non-procedure-related myocardial infarction, resuscitated cardiac arrest, or fatal or nonfatal stroke).


RESULTS
In patients 65 years of age or older, absolute risk was reduced by 2.3% and relative risk by 19% for major cardiovascular events in favor of the high-dose atorvastatin group (hazard ratio, 0.81 [95% CI, 0.67 to 0.98]; P = 0.032). Among the components of the composite outcome, the mortality rates from CHD, nonfatal non-procedure-related myocardial infarction, and fatal or nonfatal stroke (ischemic, embolic, hemorrhagic, or unknown origin) were all lower in older patients who received high-dose atorvastatin, although the difference was not statistically significant for each individual component. The improved clinical outcome in patients 65 years of age or older was not associated with persistent elevations in creatine kinase levels.


CONCLUSIONS
Because the study was a secondary analysis, the findings should be interpreted within the context of the main study results.


CONCLUSIONS
The analysis suggests that additional clinical benefit can be achieved by treating older patients with CHD more aggressively to reduce low-density lipoprotein cholesterol levels to less than 2.6 mmol/L (<100 mg/dL). The findings support the use of intensive low-density lipoprotein cholesterol-lowering therapy in high-risk older persons with established cardiovascular disease. Click here for related information on atorvastatin.
Wenger
Nanette K
NK
Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia 30303, USA. nwenger@emory.edu
Lewis
Sandra J
SJ
Herrington
David M
DM
Bittner
Vera
V
Welty
Francine K
FK
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000924:Anticholesteremic Agents / Q000008:administration & dosage*; D000069059:Atorvastatin; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D008078:Cholesterol, LDL / Q000097:blood; D003327:Coronary Disease / Q000097:blood / Q000188:drug therapy*; D005260:Female; D006538:Heptanoic Acids / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D011758:Pyrroles / Q000008:administration & dosage*; D016896:Treatment Outcome; D014280:Triglycerides / Q000097:blood
D000924:Anticholesteremic Agents; D008078:Cholesterol, LDL; D006538:Heptanoic Acids; D011758:Pyrroles; D014280:Triglycerides; D000069059:Atorvastatin