PROVE IT-TIMI 22- Sub-analysis in Elderly

26 Aug, 10

PROVE IT-TIMI 22- Sub-analysis in Elderly

Introduction

Aggressive LDL lowering to achieve the NCEP goal of LDL <70 mg/dl in elderly ACS patients is as safe and effective as in younger patients: Sub-analysis of Pravastatin or Atorvastatin Evaluation and Infection Therapy- Thrombolysis in Myocardial Infarction (PROVE IT-TIMI) 22 trial

Aim

To assess the benefit of achieving the NCEP LDL goal of <70 mg/dl among acute coronary syndrome (ACS) patients >70 years

Study Design and Participants

Post hoc analysis of PROVE-IT TIMI 22 study participants comprising
730 elderly patients: age >70 years
3432 younger patients: age <70 years

Interventions

Pravastatin 40 mg/day (n=479) or atorvastatin 80 mg/day (n=499)
Mean follow up period was 2 years

Outcome Measures

Acute cardiac clinical events of death, myocardial infarction (MI) or unstable angina (UA) requiring hospitalization
Relationship between attaining NCEP goals and the subsequent risk of the primary endpoint (composite of death, MI, UA requiring rehospitalization, revascularization with percutaneous coronary intervention (PCI) or coronary artery bypass surgery occurring at least 30 days following randomization or stroke) of PROVE-IT TIMI 22 study

Results

Significantly greater number of patients in both age groups achieved NCEP LDL goals with intensive regimen of atorvastatin as compared to pravastatin (Figure 1)

Figure 1. Comparison of LDL goal attainment

As compared to older patients who did not attain the LDL goal of <70 mg/dl, those older patients who achieved the goal had a significant 40% reduction in the risk of the primary endpoint
Achieving the optional LDL goal could potentially prevent nearly four times as many acute events among elderly patients as compared to younger counterparts (Figure 2)

Figure 2. Absolute reduction in death, MI or UA

Safety

The incidence of major adverse events were similar to that in younger patients and did not differ with the intensity of statin regimen

Conclusion

Routine use of statins at hospital discharge after ACS and achieving the NCEP optional LDL goal could be a simple and effective prevention strategy among the elderly

Eur Heart J 2006; 27: 2310-6