More support for high-dose atorvastatin in coronary artery disease

Previous studies have shown that intensive lipid lowering with atorvastatin has advantages over moderate lipid lowering with pravastatin in patients with coronary heart disease. An important question that remains is whether atorvastatin has advantages over other statins per se, or whether it is the dose of atorvastatin that is important. The Treating to New Targets (TNT) study compared atorvastatin 80 and 10 mg/day on clinical end points in patients with stable coronary disease. After a median follow up of 4.9 years, events (death from coronary heart disease, nonfatal myocardial infarction, resuscitation after cardiac arrest, or stroke) had occurred in 8.7% of the high-dose atorvastatin patients compared with 10.9% taking atorvastatin 10 mg/day. A magnetic resonance imaging study that compared the effects of atorvastatin 5 and 20 mg on aortic atherosclerosis showed that there was no effect with atorvastatin 5 mg over 12 months, suggesting prevention of progression, whereas atorvastatin 20 mg produced regression. These studies show that the dose of atorvastatin is important in coronary heart disease, with the more intensive the lipid-lowering, the greater the benefits with atorvastatin.