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| |  Intensive Lipid Lowering Reduces Cardiovascular Events in High-Risk Patients: Reported at ACC By Bruce Sylvester ATLANTA -- March 15, 2010 -- Intensive lipid lowering with atorvastatin significantly reduces the risk of peripheral artery disease (PAD) compared with standard simvastatin therapy for patients with no history of PAD, but not for those with PAD history. However, intensive atorvastatin therapy significantly reduces the risk of coronary, cardiovascular disease or revascularisation, without regard to baseline PAD status. “We confirmed that intensive lipid lowering with atorvastatin lowers the risk of future cardiovascular events due to peripheral artery disease, for which there is a high risk of such events in these patients,” said presenter and lead investigator Mogens Larsen, MD, Odense University Medical School, Odense, Denmark, here today at the 59th Annual Scientific Sessions of the American College of Cardiology (ACC). Dr. Larsen presented a subanalysis of data from the Incremental Decrease in Events Through Aggressive Lipid Lowering (IDEAL). IDEAL enrolled 8,888 patients with a prior MI and the researchers reported a relative risk reduction 11% in major coronary events after treatment with high-dose (80 mg) atorvastatin compared with standard dose (20-40 mg) simvastatin (P = .07) over 4.8 years of follow-up. In this new subanalysis of IDEAL, investigators analysed the effect of intensive lipid lowering with atorvastatin 80 mg vs simvastatin 20 to 40 mg on the incidence of PAD, and on the ensuing cardiovascular effects of having a PAD diagnosis at baseline in the original trial. In order to analyse the predictive effect of baseline PAD, standard multivariate statistical analysis was conducted and included the variables of medical treatment, age, gender, baseline systolic blood pressure, diastolic blood pressure, body mass index, history of more than one previous MI, cerebrovascular disease, PAD, congestive heart failure, smoking status, systemic hypertension, diabetes, pretrial statin use, baseline low-density lipoprotein cholesterol, high-density lipoprotein blocker use, angiotensin-converting enzyme inhibitor use, and angiotensin II receptor blocker use. The investigators found that PAD appeared in 127 atorvastatin-treated patients (2.9%) and in 167 simvastatin-treated patients (3.8%), with a 24% reduction in relative risk for atorvastatin subjects (hazard ratio [HR] = 0.76; 95% confidence interval [CI], 0.61-0.96; P = .02). They found that factors predicting development of PAD in the trial were a history of PAD, age >65 years, cerebrovascular disease, systolic blood pressure, hypertension, diabetes, smoking, elevated apolipoprotein B (Apo B), and elevated Apo B/Apo A1. Of the patients with a PAD diagnosis at baseline (4.2%), the investigators found that the risk of major coronary events was almost twice that of patients without PAD at baseline (HR = 1.92; 95% CI, 1.49-2.47; P < .0001). Patients with PAD at baseline also had significantly higher rates of major cardiovascular events (P < .0001), stroke (P = .0003), and all-cause death (P < .0001), compared with those without a history of PAD. The investigators also found that, among patients with PAD at baseline, the rate of major coronary events during the study was lower in the atorvastatin cohort (14.4%) than the simvastatin cohort (20.1%; HR = 0.68; 95% CI, 0.41-1.11; P = .125). Notably, in this same baseline PAD patient group, the researchers found a significant atorvastatin treatment effect for reduction of any coronary event (P = .04), revascularisation (P = .007), and any cardiovascular event (P < .05), but not ensuing for PAD (P = .605). Funding for this study was provided by Pfizer. [Presentation title: Effects of Intensive Lipid Lowering With Atorvastatin on Peripheral Arterial Disease in Patients With Coronary Heart Disease. Abstract 1002-31]
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