TREATING PATIENTS WITH DOCUMENTED ATHEROSCLEROSIS TO NATIONAL CHOLESTEROL EDUCATION PROGRAM-RECOMMENDED LOW-DENSITY-LIPOPROTEIN CHOLESTEROLGOALS WITH ATORVASTATIN, FLUVASTATIN, LOVASTATIN AND SIMVASTATIN

Objectives. This study compared the efficacy and safety of atorvastati n, fluvastatin, lovastatin, and simvastatin in patients with documente d atherosclerosis treated to U.S. National Cholesterol Education Progr am (NCEP) recommended low-density-lipoprotein (LDL) cholesterol concen tration (less than or equal to 100 mg/dl [2.59 mmol/liter]). Backgroun d. For patients with advanced atherosclerosis, NCEP recommends lipid l owering drug therapy if LDL cholesterol remains greater than or equal to 130 mg/dl (3.36 mmol/liter). Methods. A total of 318 men or women w ith documented atherosclerosis and LDL cholesterol greater than or equ al to 130 mg/dl (3.36 mmol/liter) and less than or equal to 250 mg/dl (6.5 mmol/liter), and triglycerides less than or equal to 400 mg/dl (4 .5 mmol/liter) participated in this 54-week, multicenter, open-label, randomized, parallel-group, active-controlled treat to-target study. P atients were titrated at 12-week intervals until the LDL cholesterol g oal was reached. Number of patients reaching target LDL cholesterol le vels and dose to reach target were evaluated. Results. At the starting doses, atorvastatin 10 mg produced significantly greater decreases (p < 0.05) in plasma LDL cholesterol than the other treatments. Subseque ntly, the percentage of patients reaching goal at the starting dose wa s 32% for atorvastatin, 1% for fluvastatin, 10% for lovastatin and 22% for simvastatin. Atorvastatin-treated patients required a lower media n dose than other treatments. Median doses at week 54,vith the last av ailable visit carried forward were atorvastatin 20 mg/day, fluvastatin 40 mg/day + colestipol 20 g/day, lovastatin 80 mg/day, simvastatin 40 mg/day. Conclusions. A significantly greater number (p < 0.05) of pat ients with confirmed atherosclerosis treated with atorvastatin reached the target LDL cholesterol concentration at the starting dose than pa tients treated with fluvastatin or lovastatin, and significantly fewer (p < 0.05) patients treated,vith atorvastatin required combination th erapy with colestipol to achieve target LDL cholesterol concentrations than all other statins tested. (J Am Cell Cardiol 1998;32:665-72) (C) 1998 by the American College of Cardiology.