Effects of intensive versus moderate lipid-lowering therapy on myocardial ischemia in older patients with coronary heart disease : Results of the study assessing goals in the elderly (SAGE)

• Published in: Circulation (New York, N.Y.) Vol. 115; no. 6; pp. 700 - 707
• Main Authors: DEEDWANIA, Prakash, STONE, Peter H, STEIN, James H, THOMPSON, Peter L, TZIVONI, Dan, BAIREY MERZ, C. Noel, COSIN-AGUILAR, Juan, KOYLAN, Nevres, DON LUO, OUYANG, Pamela, PIOTROWICZ, Ryszard, SCHENCK-GUSTAFSSON, Karin, SELLIER, Philippe
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 13.02.2007
• Subjects: Aged; Aged, 80 and over; Anticholesteremic Agents - therapeutic use; Atorvastatin Calcium; Biological and medical sciences; Blood and lymphatic vessels; Cardiology. Vascular system; Cardiovascular system; Cholesterol, HDL - blood; Cholesterol, LDL - blood; Coronary Disease - blood; Coronary Disease - drug therapy; Coronary Disease - mortality; Coronary heart disease; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Female; Heart; Heptanoic Acids - adverse effects; Heptanoic Acids - therapeutic use; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use; Medical sciences; Medicin och hälsovetenskap; Myocardial Ischemia - prevention & control; Pharmacology. Drug treatments; Pravastatin - adverse effects; Pravastatin - therapeutic use; Pyrroles - adverse effects; Pyrroles - therapeutic use; Sex Characteristics; Vasodilator agents. Cerebral vasodilators; Human; Metabolic diseases; Cardiovascular disease; Myocardial ischemia; Lipids; Hyperlipoproteinemia; Statin derivative; Lipoprotein; Myocardial disease; Coronary heart disease; Cholesterol; ischemia; Vascular disease; Hypercholesterolemia; Treatment; statins; Atherosclerosis; Electrocardiography; Dyslipemia; Elderly; Comparative study; Antilipemic agent
• ISSN: 0009-7322; 1524-4539; 1524-4539
• DOI: 10.1161/CIRCULATIONAHA.106.654756

Clinical trials have demonstrated that, compared with placebo, intensive statin therapy reduces ischemia in patients with acute coronary syndromes and in patients with stable coronary artery disease. However, no studies to date have assessed intensive versus moderate statin therapy in older patients with stable coronary syndromes. A total of 893 ambulatory coronary artery disease patients (30% women) 65 to 85 years of age with > or = 1 episode of myocardial ischemia that lasted > or = 3 minutes during 48-hour ambulatory ECG at screening were randomized to atorvastatin 80 mg/d or pravastatin 40 mg/d and followed up for 12 months. The primary efficacy parameter (absolute change from baseline in total duration of ischemia at month 12) was significantly reduced in both groups at month 3 and month 12 (both P<0.001 for each treatment group) with no significant difference between the treatment groups. Atorvastatin-treated patients experienced greater low-density lipoprotein cholesterol reductions than did pravastatin-treated patients, a trend toward fewer major acute cardiovascular events (hazard ratio, 0.71; 95% confidence interval, 0.46, 1.09; P=0.114), and a significantly greater reduction in all-cause death (hazard ratio, 0.33; 95% confidence interval, 0.13, 0.83; P=0.014). Compared with moderate pravastatin therapy, intensive atorvastatin therapy was associated with reductions in cholesterol, major acute cardiovascular events, and death in addition to the reductions in ischemia observed with both therapies. The contrast between the therapies' differing efficacy for major acute cardiovascular events and death and their nonsignificant difference in efficacy for reduction of ischemia suggests that low-density lipoprotein cholesterol-lowering thresholds for ischemia and major acute cardiovascular events may differ. The Study Assessing Goals in the Elderly (SAGE) demonstrates that older men and women with coronary artery disease benefit from intensive statin therapy.