TY - JOUR T1 - Reduction in recurrent cardiovascular events with intensive lipid-lowering statin therapy compared with moderate lipid-lowering statin therapy after acute coronary syndromes from the PROVE IT-TIMI 22 (Pravastatin or Atorvastatin Evaluation and Infection Therapy-Thrombolysis In Myocardial Infarction 22) trial. AU - Murphy,Sabina A, AU - Cannon,Christopher P, AU - Wiviott,Stephen D, AU - McCabe,Carolyn H, AU - Braunwald,Eugene, PY - 2009/05/07/received PY - 2009/09/30/revised PY - 2009/10/12/accepted PY - 2010/1/20/entrez PY - 2010/1/20/pubmed PY - 2010/3/5/medline SP - 2358 EP - 62 JF - Journal of the American College of Cardiology JO - J Am Coll Cardiol VL - 54 IS - 25 N2 - OBJECTIVES: In addition to reducing first events in patients after an acute coronary syndrome (ACS), we hypothesized that high-dose atorvastatin 80 mg would also reduce recurrent cardiovascular events, and therefore total events, compared with pravastatin 40 mg during the 2-year follow-up. BACKGROUND: In the PROVE IT-TIMI 22 (Pravastatin or Atorvastatin Evaluation and Infection Therapy-Thrombolysis In Myocardial Infarction 22) trial, more intensive lipid lowering with high-dose atorvastatin reduced the first occurrence of the primary end point (death, myocardial infarction, unstable angina requiring rehospitalization, stroke, or revascularization > or = 30 days) compared with moderate lipid lowering with pravastatin. METHODS: Poisson regression analysis was performed to compare the number of occurrences of the primary end point between high-dose atorvastatin and pravastatin in the PROVE IT-TIMI 22 trial. RESULTS: As previously reported, first primary end point events were reduced by 16% with atorvastatin 80 mg versus pravastatin 40 mg (n = 464 vs. n = 537, respectively; p = 0.005). Additional events were also reduced by 19% with atorvastatin 80 mg (n = 275 vs. n = 340, respectively; p = 0.009). Overall, there were 138 fewer primary efficacy events with atorvastatin 80 mg versus pravastatin 40 mg (n = 739 vs. n = 877, respectively; rate ratio: 0.85, 95% confidence interval: 0.77 to 0.94, p = 0.001). CONCLUSIONS: Although analytic techniques commonly used in clinical outcomes trials censor patients who experience a component of the primary composite end point, total cardiovascular events are important to patients, clinicians, and health care payers. Maintaining low levels of low-density lipoprotein cholesterol is central to preventing additional atherosclerotic development and subsequent cardiovascular events. Atorvastatin 80 mg, a more intensive low-density lipoprotein cholesterol lowering agent, reduced both first and subsequent primary end point events compared with pravastatin 40 mg after ACS. SN - 1558-3597 UR - https://www.unboundmedicine.com/medline/citation/20082923/Reduction_in_recurrent_cardiovascular_events_with_intensive_lipid_lowering_statin_therapy_compared_with_moderate_lipid_lowering_statin_therapy_after_acute_coronary_syndromes_from_the_PROVE_IT_TIMI_22__Pravastatin_or_Atorvastatin_Evaluation_and_Infection_Therapy_Thrombolysis_In_Myocardial_Infarction_22__trial_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0735-1097(09)03325-7 DB - PRIME DP - Unbound Medicine ER -