Aggressive lipid-lowering benefits bypass patients
NEW YORK (Reuters Health) - In patients who have had heart bypass surgery, taking the cholesterol-lowering drug Lipitor at a dose of 80 milligrams per day, rather than 10 milligrams per day, can markedly improve outcomes, new research shows.
Major heart-related "events" fell by 27 percent and the need for repeat heart procedures dropped by 30 percent with use of higher-dose Lipitor, researchers found.
Because heart bypass surgery patients represent an "especially high-risk population that tends to be under treated with lipid-lowering therapy, this treatment should be the new standard of care," with the goal of reducing heart-related illness and death, they conclude.
The findings stem from a post-hoc analysis of the Treating to New Targets, or TNT, trial.
As part of the trial, 4,654 patients who had heart bypass surgery were randomized to receive Lipitor (also called atorvastatin) at the lower or higher dose and were followed for a median of 4.9 years.
By the end of the study, the average levels of "bad" LDL-cholesterol were much lower in patients taking 80 milligrams of Lipitor daily than in those taking 10 milligrams daily, Dr. Sanjiv J. Shah, from San Francisco General Hospital, and colleagues report.
Moreover, 9.7 percent of those taking high-dose Lipitor suffered a major cardiovascular event (cardiac death, nonfatal heart attack, resuscitated cardiac arrest, or stroke) compared with 13 percent of patients taking low-dose Lipitor.
There were also fewer repeat bypass operations or angioplasty procedures in the higher dose arm of the study (11.3 percent vs. 15.9 percent).
This study, conclude Shah and colleagues, shows that "aggressive lipid-lowering" with atorvastatin 80 mg decreases major cardiovascular events and the need for repeat heart procedures in patients who've had heart bypass surgery.
SOURCE: Journal of the American College of Cardiology, May 20, 2008.