Fluvastatin for prevention of cardiac events following successful first percutaneous coronary intervention: a randomized controlled trial.
Patrick W. Serruys,Pim J. de Feyter,Carlos Macaya,Norbert Kokott,Jacques Puel,Matthias Vrolix,Angelo Branzi,M. C. Bertolami,Graham Jackson,Bradley H. Strauss,Bernhard Meier +10 more
TLDR
Fuvastatin treatment in patients with average cholesterol levels undergoing their first successful PCI significantly reduces the risk of major adverse cardiac events.Abstract:
CONTEXT: Percutaneous coronary intervention (PCI) is associated with excellent short-term improvements in ischemic symptoms, yet only three fifths of PCI patients at 5 years and one third of patients at 10 years remain free of major adverse cardiac events (MACE). OBJECTIVE: To determine whether treatment with fluvastatin reduces MACE in patients who have undergone PCI. DESIGN AND SETTING: Randomized, double-blind, placebo-controlled trial conducted at 77 referral centers in Europe, Canada, and Brazil. PATIENTS: A total of 1677 patients (aged 18-80 years) recruited between April 1996 and October 1998 with stable or unstable angina or silent ischemia following successful completion of their first PCI who had baseline total cholesterol levels between 135 and 270 mg/dL (3.5-7.0 mmol/L), with fasting triglyceride levels of less than 400 mg/dL (4.5 mmol/L). INTERVENTIONS: Patients were randomly assigned to receive treatment with fluvastatin, 80 mg/d (n = 844), or matching placebo (n = 833) at hospital discharge for 3 to 4 years. MAIN OUTCOME MEASURE: Survival time free of MACE, defined as cardiac death, nonfatal myocardial infarction, or reintervention procedure, compared between the treatment and placebo groups. RESULTS: Median time between PCI and first dose of study medication was 2.0 days, and median follow-up was 3.9 years. MACE-free survival time was significantly longer in the fluvastatin group (P =.01). One hundred eighty-one (21.4%) of 844 patients in the fluvastatin group and 222 (26.7%) of 833 patients in the placebo group had at least 1 MACE (relative risk [RR], 0.78; 95% confidence interval [CI], 0.64-0.95; P =.01). This result was independent of baseline total cholesterol levels (above [RR, 0.76; 95% CI, 0.56-1.04] vs below [RR, 0.77; 95% CI, 0.57-1.02] the median). In subgroup analysis, the risk of MACE was reduced in patients with diabetes (n = 202; RR, 0.53; 95% CI, 0.29-0.97; P =.04) and in those with multivessel disease (n = 614; RR, 0.66; 95% CI, 0.48-0.91; P =.01) who received fluvastatin compared with those who received placebo. There were no instances of creatine phosphokinase elevations 10 or more times the upper limit of normal or rhabdomyolysis in the fluvastatin group. CONCLUSION: Fluvastatin treatment in patients with average cholesterol levels undergoing their first successful PCI significantly reduces the risk of major adverse cardiac events.read more
Citations
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2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines
Neil J. Stone,Jennifer G. Robinson,Alice H. Lichtenstein,C. Noel Bairey Merz,Conrad B. Blum,Robert H. Eckel,Anne C. Goldberg,David Lee Gordon,Daniel Levy,Donald M. Lloyd-Jones,Patrick E. McBride,J. Sanford Schwartz,Susan T. Shero,Sidney C. Smith,Karol E. Watson,Peter W.F. Wilson +15 more
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Efficacy and safety of cholesterol-lowering treatment: prospective meta-analysis of data from 90,056 participants in 14 randomised trials of statins.
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TL;DR: Statin therapy can safely reduce the 5-year incidence of major coronary events, coronary revascularisation, and stroke by about one fifth per mmol/L reduction in LDL cholesterol, largely irrespective of the initial lipid profile or other presenting characteristics.
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ACC/AHA guidelines for the management of patients with unstable angina and non-ST-segment elevation myocardial infarction: Executive summary and recommendations: A report of the American College of Cardiology/American Heart Association task force on practice guidelines (committee on the management of patients with unstable angina)
Eugene Braunwald,Elliott M. Antman,John W. Beasley,Robert M. Califf,Melvin D. Cheitlin,Judith S. Hochman,Robert H. Jones,Dean J. Kereiakes,Joel Kupersmith,Thomas N. Levin,Carl J. Pepine,John W. Schaeffer,Earl E. Smith,David E Steward,Pierre Theroux,Raymond J. Gibbons,Joseph S. Alpert,David P. Faxon,Valentin Fuster,Gabriel Gregoratos,Loren F. Hiratzka,Alice K. Jacobs,Sidney C. Smith +22 more
TL;DR: The present guidelines supersede the 1994 guidelines and summarize both the evidence and expert opinion and provide final recommendations for both patient evaluation and therapy.
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Colin Baigent,L Blackwell,Jonathan Emberson,Lisa Holland,Christina Reith,Neeraj Bhala,Richard Peto,Elizabeth H Barnes,Anthony C Keech,John Simes,Rory Collins +10 more
TL;DR: Further reductions in LDL cholesterol safely produce definite further reductions in the incidence of heart attack, of revascularisation, and of ischaemic stroke, with each 1·0 mmol/L reduction reducing the annual rate of these major vascular events by just over a fifth.
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References
More filters
Journal ArticleDOI
Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III)
Scott M. Grundy,David W. Bilheimer,Alan Chait,Luther T. Clark,Margo A. Denke,Richard J. Havel,William R. Hazzard,Stephen B. Hulley,Donald B. Hunninghake,Robert A. Kreisberg,Penny M. Kris-Etherton,James M. McKenney,Michael A. Newman,Ernst J. Schaefer,Burton E. Sobel,Carolyn Somelofski,Milton C. Weinstein,H. Bryan Brewer,James I. Cleeman,Karen A. Donato,Nancy D. Ernst,Jeffrey M. Hoeg,Basil M. Rifkind,Jacques E. Rossouw,Christopher T. Sempos,Joanne M. Gallivan,Maureen N. Harris,Laurie Quint-Adler +27 more
TL;DR: Dairy therapy remains the first line of treatment of high blood cholesterol, and drug therapy is reserved for patients who are considered to be at high risk for CHD, and the fundamental approach to treatment is comparable.
Journal Article
Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S)
Anders G. Olsson,Jjv McMurray,Gudmundur Thorgeirsson,C Spaulding,J Slattery,Kalevi Pyörälä,Ole Faergeman,RA Wright,Kåre Berg,Lars Wilhelmsen,Terje R. Pedersen,Tatu A. Miettinen,Harvey D. White,John Kjekshus,Michael Gnant +14 more
Journal ArticleDOI
The Effect of Pravastatin on Coronary Events after Myocardial Infarction in Patients with Average Cholesterol Levels
Frank M. Sacks,Marc A. Pfeffer,Lemuel A. Moyé,Jean L. Rouleau,John D. Rutherford,Thomas G. Cole,Lisa E. Brown,J. W. Warnica,J. M. O. Arnold,Chuan Chuan C Wun,Barry R. Davis,Eugene Braunwald +11 more
TL;DR: It is demonstrated that the benefit of cholesterol-lowering therapy extends to the majority of patients with coronary disease who have average cholesterol levels and was also greater in patients with higher pretreatment levels of LDL cholesterol.
Journal ArticleDOI
Prevention of cardiovascular events and death with pravastatin in patients with coronary heart disease and a broad range of initial cholesterol levels
Andrew Tonkin,P. Alyward,David Colquhoun,Paul Glasziou,P. Harris,D. Hunt,Anthony C Keech,Stephen MacMahon,P. Magnus,D. Newel,P. Nestel,N. Sharpe,J. Shaw,R. J. Simes,P. Thompson,Alexis A. Thompson,Malcolm J. West,H. White,S. Simes,Wendy Hague,Sue Caleo,Jane Hall,Andrew J. Martin,S. Mulray,Philip J. Barter,Lawrence J. Beilin,Rory Collins,John J McNeil,Petra Meier,H. Willimott,D. Smithers,P. Wallace,J. Baker,M. Hobbs,David R. Sullivan,N. Anderson,Graeme J. Hankey,John D.G. Watson,M. Arulchelvam,S. Chup,John Daly,J. Hanna,A. Leach,M. Lee,J. Loughhead,H. Lundie-Jenkin,J. Morrison,S. Netting,A. Nguyen,H. Pater,R. Philip,G. Pinna,D. Rattos,S. Ryerson,V. Sazhin,Richard Walsh,A. Claque,M. Mackie,Julie Jane Yallop,K. Boss,M. Shepard,J. Leach,M. Gandy,J. Joughin,J. Seabrook,R. Abraham,J. Allen,F. Bates,I. Beinart,E. Breed,D. Brown,N. Bunyan,D. Calvert,T. Campbell,D. Condon-Paoloni,B. Conway,Lucy A. Coupland,J. Crowe,N. Cunio,B. Cuthbert,N. Cuthbert,S. D'Arcy,Patricia M. Davidson,B. Dwyer,J. England,C. Friend,Greg Fulcher,S. Grant,K. Hellestrand,M. Kava,Leonard Kritharides,D. McGill,H. McKee,Allan J. McLean,M. Neaverson,G. Nelson,M. O'Neill,C. Onuma,F. O'Reilly +98 more
TL;DR: Pravastatin therapy reduced mortality from coronary heart disease and overall mortality, as compared with the rates in the placebo group, as well as the incidence of all prespecified cardiovascular events in patients with a history of myocardial infarction or unstable angina who had a broad range of initial cholesterol levels.
Journal ArticleDOI
Diabetes, other risk factors, and 12-yr cardiovascular mortality for men screened in the Multiple Risk Factor Intervention Trial.
TL;DR: Findings emphasize the need for rigorous sustained intervention in people with diabetes to control blood pressure, lower serum cholesterol, and abolish cigarette smoking, and the importance of considering nutritional-hygienic approaches on a mass scale to prevent diabetes.
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