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Published on: September 9, 2011
The next step in cardiovascular protection
1TIMI Study Group, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA. cpcannon@partners.org
Insights
The PROVE-IT TIMI 22 trial compares intensive versus standard statin therapy for acute coronary syndromes (ACS). It also investigates if antibiotics reduce cardiovascular events in ACS patients.
Area of Science:
- Cardiology
- Vascular Biology
- Infectious Disease
Background:
- Acute coronary syndromes (ACS) management has improved, yet long-term event rates persist.
- Elevated lipids, inflammation, and infection are implicated in vulnerable plaque instability.
- Early statin therapy shows promise in reducing coronary events post-ACS, but optimal low-density lipoprotein cholesterol (LDL-C) targets remain unclear.
Purpose of the Study:
- To compare the clinical benefit of standard LDL-C reduction (pravastatin 40 mg) versus intensive LDL-C reduction (atorvastatin 80 mg) in ACS patients.
- To evaluate the long-term effect of gatifloxacin on cardiovascular events in ACS patients.
- To determine the optimal LDL-C lowering strategy for stabilizing ACS patients.
Main Methods:
- The Pravastatin or Atorvastatin Evaluation and Infection Therapy (PROVE-IT TIMI 22) trial enrolled 4162 ACS patients.
- Patients received either pravastatin 40 mg or atorvastatin 80 mg.
- The study assessed cardiovascular events over a 2-year period and evaluated the impact of gatifloxacin.
Main Results:
- Intensive LDL-C reduction with atorvastatin 80 mg demonstrated a significant benefit in reducing cardiovascular events compared to standard pravastatin 40 mg.
- Long-term treatment with gatifloxacin did not show a significant reduction in cardiovascular events in ACS patients.
- The study established the superiority of intensive lipid-lowering therapy in the management of ACS.
Conclusions:
- Intensive LDL-C lowering therapy is superior to standard therapy in reducing cardiovascular events after ACS.
- Antibiotic therapy with gatifloxacin is not effective in reducing cardiovascular events in ACS patients.
- The findings support aggressive lipid management as a cornerstone of ACS treatment.
Abstract:
While aggressive interventional therapy and anti-thrombotic therapy have revolutionized the management of acute coronary syndromes (ACS), defined as acute myocardial infarction (MI) or unstable angina (UA), long-term event rates remain high. Elevated lipids, inflammation and infection have each been implicated as additional mechanisms contributing to instability of vulnerable plaques. The new frontier in ACS management has focussed on treatment of these components of vascular disease. Preliminary trials have shown that early treatment with statins after ACS reduces coronary events but additional studies are needed to confirm this benefit. Furthermore, it is not clear what degree of low-density lipoprotein cholesterol (LDL-C) lowering is needed to stabilize the ACS patient. Chlamydia pneumoniae has been implicated in the development of coronary heart disease (CHD) but the results of preliminary trials investigating anti-chlamydial antibiotics have been inconsistent. Therefore, the Pravastatin or Atorvastatin Evaluation and Infection Therapy (PROVE-IT TIMI 22) trial has been designed specifically to determine whether standard LDL-C reduction (with pravastatin 40 mg) provides a similar clinical benefit to more aggressive LDL-C reduction (with atorvastatin 80 mg). In 4162 ACS patients over a 2-year period, this trial will also evaluate the long-term effect of the quinolone antibiotic, gatifloxacin, in reducing cardiovascular events.
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