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ISCHAEMIC HEART DISEASE
Atorvastatin 80 mg for all ACS patients? ▸
Patients with acute coronary syndrome (ACS) need lipid lowering agents. How low should the LDL (low density lipoprotein) cholesterol value go? A total of 4162 patients who had ACS < 10 days before received either 40 mg of pravastatin (standard treatment) or 80 mg of atorvastatin daily (intensive treatment). The primary end point was a composite of death from any cause, myocardial infarction, documented unstable angina requiring rehospitalisation, revascularisation (performed at least 30 days after randomisation), and stroke. Follow up lasted a mean of two years. The median LDL cholesterol concentration achieved during treatment was 95 mg/dl (2.46 mmol/l) in the standard dose pravastatin group and 62 mg/dl (1.60 mmol/l) in the high dose atorvastatin group (p < 0.001). Kaplan-Meier estimates of the rates of the primary end point at two years were 26.3% in the pravastatin group versus 22.4% in the atorvastatin group (16% reduction in favour of atorvastatin, p = 0.005; 95% confidence interval (CI) 5% to 26%).
A new way to raise HDL ▸
Low HDL (high density lipoprotein) cholesterol is an independent risk factor for coronary heart disease. Statins have only …