Efficacy of High-Intensity Atorvastatin for Asian Patients Undergoing Percutaneous Coronary Intervention
Zhi Liu1, Herrmann Joerg2, Hengjian Hao1
1Xuanwu Hospital Capital Medical University, Beijing, China.
Insights
High-intensity statin therapy showed no significant difference in major adverse cardiovascular events for stable angina patients but proved superior for acute coronary syndrome patients in a Chinese population.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Trials
Background:
- Statins offer cardioprotection, but high doses raise concerns and may not improve outcomes in Asian populations.
- Understanding optimal statin intensity is crucial for cardiovascular disease management in diverse ethnic groups.
Purpose of the Study:
- To evaluate the efficacy of high-intensity statin therapy versus moderate-intensity in reducing periprocedural myocardial infarction and 1-year major adverse cardiovascular events (MACEs) in Chinese patients.
- To determine if high-intensity statin therapy offers superior clinical benefits in specific cardiovascular conditions within an Asian population.
Main Methods:
- A randomized trial involving 798 Chinese patients with stable angina or acute coronary syndrome (ACS).
- Patients received either high-intensity atorvastatin (80 mg pre-PCI, 40 mg post-PCI) or moderate-intensity atorvastatin (20 mg) for 1 year.
- The primary endpoint was the 1-year incidence of MACEs (cardiovascular death, MI, unplanned revascularization).
Main Results:
- No significant difference in 1-year MACE rates between moderate- and high-intensity atorvastatin groups for stable angina patients (7.6% vs 5.7%, P=0.53).
- In contrast, patients with ACS showed a significantly lower 1-year MACE rate with high-intensity atorvastatin compared to moderate-intensity (10.1% vs 16.8%, P=0.021).
- High-intensity statin therapy demonstrated a 1.71-fold adjusted hazard ratio for reduced MACEs in ACS patients.
Conclusions:
- Moderate- and high-intensity atorvastatin yield similar 1-year benefits for stable angina patients undergoing PCI.
- High-intensity statin therapy is clinically superior to moderate-intensity therapy in reducing MACEs for Asian patients with acute coronary syndrome.
Background:
Statins have proven cardioprotective effects, but higher doses are accompanied by various concerns and may not lead to superior clinical outcomes in Chinese/Asian populations.
Objective:
We designed a trial to test the efficacy of high-intensity statin therapy for the reduction of periprocedural myocardial infarction (MI) and 1-year major adverse cardiovascular events (MACEs, including cardiovascular death, spontaneous MI, unplanned revascularization) in an Asian population.
Methods:
A total of 798 Chinese patients with stable angina or acute coronary syndrome (ACS) were randomized to high-intensity atorvastatin (80 mg/d before percutaneous coronary intervention [PCI] and 40 mg/d thereafter for 1 year, n = 400) or moderate-intensity atorvastatin (20 mg/d for 1 year, n = 398). The primary end point was 1-year incidence of MACEs.
Result:
In patients with stable angina, 1-year MACE rates were not significantly different between moderate- and high-intensity groups (7.6% vs 5.7%, P = 0.53). In contrast, in patients with ACS, the 1-year MACE rate was significantly higher in the moderate- than in the high-intensity atorvastatin group (16.8% vs 10.1%, P = 0.021; adjusted hazard ratio = 1.71, 95% CI = 1.08 to 2.77, P = 0.021).
Conclusions:
Whereas stable angina patients derive similar benefit from moderate- and high-intensity atorvastatin therapy over the duration of 1 year after PCI, high-intensity statin therapy is superior in ACS patients.
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