© 2004 by BMJ Publishing Group & British Cardiac Society
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ISCHAEMIC HEART DISEASE
PROVE-IT proved the benefits of atorvastatin 80 mg over pravastatin 40 mg. The Z phase of the A to Z trial randomised 4500 patients who had been admitted to hospital with acute coronary syndrome (ACS) to four months placebo, or 30 days of 40 mg of simvastatin followed by 80 mg for the remainder of a four month period. Following this initial period all patients were switched to 20 mg of simvastatin once a day. Surprisingly, the higher dose regimen failed to show a significant benefit on the primary end points of cardiovascular death, myocardial infarction (MI), re-admission for ACS or stroke at four months (hazard ratio 0.89, 95% CI 0.76 to 1.04; p = 0.14), although there was some later benefit from aggressive treatment. Furthermore, side effects were particularly problematic; nine patients developed myopathy and there were three cases of frank rhabdomyolysis. In both the A to Z and
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