ISCHAEMIC HEART DISEASE

High dose statins better than low dose ▸

Statins are known to reduce atherogenic lipoproteins and hence cardiovascular morbidity and mortality. However, the impact of their varying efficacies on clinical outcome is unknown. Hence the REVERSAL (reversal of atherosclerosis with aggressive lipid lowering) study recruited 654 patients with low density lipoprotein (LDL) cholesterol concentrations between 3.24–5.44 mmol/l and an angiographically proven narrowing of 20% or more. Participants were randomised to 18 months of intensive treatment with atorvastatin 80 mg or moderate treatment with pravastatin 40 mg. Those in the intensive treatment group showed significantly reduced progression of coronary artery stenosis as assessed by intravascular ultrasound, with some actually showing disease regression. These differences may be due to the greater reduction in atherogenic lipoproteins and C reactive protein caused by atorvastatin.

Simvastatin lowers the risk of stroke ▸

A total of 3280 adults with cerebrovascular disease, and an additional 17 256 with other occlusive arterial disease or diabetes, were randomly allocated 40 mg simvastatin daily or matching placebo. Overall, there was a highly significant 25% (95% confidence interval (CI) 15% to 34%) proportional reduction in the first event rate for stroke (4.3% simvastatin v 5.7% placebo; p < 0.0001), reflecting a definite 28% (95% CI 19% to 37%) reduction in presumed ischaemic strokes (p < 0.0001) and no apparent difference in strokes attributed to haemorrhage (51 (0.5%) v 53 (0.5%); rate ratio 0.95, 95% CI 0.65 to 1.40; p  =  0.8). In addition, simvastatin reduced the numbers having transient cerebral ischaemic attacks alone (2.0% v 2.4%; p  =  0.02) or requiring carotid endarterectomy or angioplasty (0.4% v 0.8%; p  =  0.0003). The reduction in stroke was not significant during the first year, but was already significant (p  =  0.0004) by the end of the second year. Among patients with pre-existing cerebrovascular disease there was no apparent reduction in the stroke rate, but there was a highly …