Assessment of lipophilic vs. hydrophilic statin therapy in acute myocardial infarction – ALPS-AMI study.
BACKGROUND
Statins reduce the incidence of cardiovascular events, but no randomized trial has investigated the best statins for secondary prevention. We compared the efficacy of hydrophilic pravastatin with that of lipophilic atorvastatin in patients with acute myocardial infarction (AMI).


RESULTS
A prospective, multicenter study enrolled 508 patients (410 men; mean age, 66.0 ± 11.6 years) with AMI who were randomly assigned to atorvastatin (n=255) or pravastatin (n=253). The target control level of low-density lipoprotein cholesterol (LDL-C) was <100 mg/dl, and patients were followed for 2 years. The primary endpoint was the composite of death due to any cause, non-fatal myocardial infarction, non-fatal stroke, unstable angina or congestive heart failure requiring hospital admission, or any type of coronary revascularization. The primary endpoint occurred in 77 patients (30.4%) and in 80 patients (31.4%) in the pravastatin and atorvastatin groups, respectively (hazard ratio, 1.181; 95% confidence interval: 0.862-1.619; P=0.299), whereas greater reductions in serum total cholesterol and LDL-C were achieved in the atorvastatin group (P<0.001 for each). Changes in hemoglobin A1c, brain natriuretic peptide, and creatinine were not significant between the 2 regimens, and safety and treatment adherence were similar.


CONCLUSIONS
On 2-year comparison of hydrophilic and lipophilic statins there was no significant difference in prevention of secondary cardiovascular outcome.
Department of Cardiovascular Medicine, Shinshu University School of Medicine.
Atsushi
A
Izawa
Yuichiro
Y
Kashima
Takashi
T
Miura
Soichiro
S
Ebisawa
Hiroshi
H
Kitabayashi
Hiroaki
H
Yamamoto
Shunpei
S
Sakurai
Mitsuru
M
Kagoshima
Takeshi
T
Tomita
Yusuke
Y
Miyashita
Jun
J
Koyama
Uichi
U
Ikeda
D000368:Aged; D000069059:Atorvastatin / Q000737:chemistry / Q000493:pharmacokinetics / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D002784:Cholesterol / Q000145:classification; D008078:Cholesterol, LDL / Q000097:blood; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006333:Heart Failure / Q000453:epidemiology / Q000517:prevention & control; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D057927:Hydrophobic and Hydrophilic Interactions; D006937:Hypercholesterolemia / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D007564:Japan / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D008055:Lipids / Q000097:blood; D008297:Male; D008875:Middle Aged; D009026:Mortality; D009203:Myocardial Infarction / Q000097:blood* / Q000453:epidemiology / Q000209:etiology; D009204:Myocardial Revascularization / Q000706:statistics & numerical data; D010342:Patient Acceptance of Health Care; D017035:Pravastatin / Q000737:chemistry / Q000493:pharmacokinetics / Q000627:therapeutic use*; D012008:Recurrence; D016037:Single-Blind Method; D012995:Solubility
D000069059:Atorvastatin; D002784:Cholesterol; D008078:Cholesterol, LDL; D006442:Glycated Hemoglobin; D008055:Lipids; D017035:Pravastatin