Análisis crítico de un artículo: La terapia intensiva con atorvastatina tiene un beneficio marginal en pacientes con enfermedad coronaria estable

Abstract: Previous trials have demonstrated that lowering low-density lipoprotein (LDL) cholesterol levels below currently recommended levels is beneficial in patients with acute coronary syndromes. We prospectively assessed the efficacy and safety of lowering LDL cholesterol levels below 100 mg per...

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Autores principales:	Puebla A,Claudio, Vergara M,Cristian, Vallejos P,Roberto, Pizarro C,Andrés, Dodds B,Francisco, Godoy T,Cristian
Lenguaje:	Spanish / Castilian
Publicado:	Sociedad Médica de Santiago 2006
Acceso en línea:	http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872006000300020
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spelling	oai:scielo:S0034-988720060003000202006-05-02Análisis crítico de un artículo: La terapia intensiva con atorvastatina tiene un beneficio marginal en pacientes con enfermedad coronaria establePuebla A,ClaudioVergara M,CristianVallejos P,RobertoPizarro C,AndrésDodds B,FranciscoGodoy T,CristianAbstract: Previous trials have demonstrated that lowering low-density lipoprotein (LDL) cholesterol levels below currently recommended levels is beneficial in patients with acute coronary syndromes. We prospectively assessed the efficacy and safety of lowering LDL cholesterol levels below 100 mg per deciliter (2.6 mmol per liter) in patients with stable coronary heart disease (CHD). Methods: A total of 10,001 patients with clinically evident CHD and LDL cholesterol levels of less than 130 mg per deciliter (3.4 mmol per liter) were randomly assigned to double-blind therapy and received either 10 mg or 80 mg of atorvastatin per day. Patients were followed for a median of 4.9 years. The primary end point was the occurrence of a first major cardiovascular event, defined as death from CHD, nonfatal non-procedure-related myocardial infarction, resuscitation after cardiac arrest, or fatal or nonfatal stroke. Results: The mean LDL cholesterol levels were 77 mg per deciliter (2.0 mmol per liter) during treatment with 80 mg of atorvastatin and 101 mg per deciliter (2.6 mmol per liter) during treatment with 10 mg of atorvastatin. The incidence of persistent elevations in liver aminotransferase levels was 0.2 percent in the group given 10 mg of atorvastatin and 1.2 percent in the group given 80 mg of atorvastatin (P <0.001). A primary event occurred in 434 patients (8.7 percent) receiving 80 mg of atorvastatin, as compared with 548 patients (10.9 percent) receiving 10 mg of atorvastatin, representing an absolute reduction in the rate of major cardiovascular events of 2.2 percent and a 22 percent relative reduction in risk (hazard ratio, 0.78; 95 percent confidence interval, 0.69 to 0.89; P <0.001). There was no difference between the two treatment groups in overall mortality. Conclusions: Intensive lipid-lowering therapy with 80 mg of atorvastatin per day in patients with stable CHD provides significant clinical benefit beyond that afforded by treatment with 10 mg of atorvastatin per day. This occurred with a greater incidence of elevated aminotransferase levelsinfo:eu-repo/semantics/openAccessSociedad Médica de SantiagoRevista médica de Chile v.134 n.3 20062006-03-01text/htmlhttp://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872006000300020es10.4067/S0034-98872006000300020
institution	Scielo Chile
collection	Scielo Chile
language	Spanish / Castilian
description	Abstract: Previous trials have demonstrated that lowering low-density lipoprotein (LDL) cholesterol levels below currently recommended levels is beneficial in patients with acute coronary syndromes. We prospectively assessed the efficacy and safety of lowering LDL cholesterol levels below 100 mg per deciliter (2.6 mmol per liter) in patients with stable coronary heart disease (CHD). Methods: A total of 10,001 patients with clinically evident CHD and LDL cholesterol levels of less than 130 mg per deciliter (3.4 mmol per liter) were randomly assigned to double-blind therapy and received either 10 mg or 80 mg of atorvastatin per day. Patients were followed for a median of 4.9 years. The primary end point was the occurrence of a first major cardiovascular event, defined as death from CHD, nonfatal non-procedure-related myocardial infarction, resuscitation after cardiac arrest, or fatal or nonfatal stroke. Results: The mean LDL cholesterol levels were 77 mg per deciliter (2.0 mmol per liter) during treatment with 80 mg of atorvastatin and 101 mg per deciliter (2.6 mmol per liter) during treatment with 10 mg of atorvastatin. The incidence of persistent elevations in liver aminotransferase levels was 0.2 percent in the group given 10 mg of atorvastatin and 1.2 percent in the group given 80 mg of atorvastatin (P <0.001). A primary event occurred in 434 patients (8.7 percent) receiving 80 mg of atorvastatin, as compared with 548 patients (10.9 percent) receiving 10 mg of atorvastatin, representing an absolute reduction in the rate of major cardiovascular events of 2.2 percent and a 22 percent relative reduction in risk (hazard ratio, 0.78; 95 percent confidence interval, 0.69 to 0.89; P <0.001). There was no difference between the two treatment groups in overall mortality. Conclusions: Intensive lipid-lowering therapy with 80 mg of atorvastatin per day in patients with stable CHD provides significant clinical benefit beyond that afforded by treatment with 10 mg of atorvastatin per day. This occurred with a greater incidence of elevated aminotransferase levels
author	Puebla A,Claudio Vergara M,Cristian Vallejos P,Roberto Pizarro C,Andrés Dodds B,Francisco Godoy T,Cristian
spellingShingle	Puebla A,Claudio Vergara M,Cristian Vallejos P,Roberto Pizarro C,Andrés Dodds B,Francisco Godoy T,Cristian Análisis crítico de un artículo: La terapia intensiva con atorvastatina tiene un beneficio marginal en pacientes con enfermedad coronaria estable
author_facet	Puebla A,Claudio Vergara M,Cristian Vallejos P,Roberto Pizarro C,Andrés Dodds B,Francisco Godoy T,Cristian
author_sort	Puebla A,Claudio
title	Análisis crítico de un artículo: La terapia intensiva con atorvastatina tiene un beneficio marginal en pacientes con enfermedad coronaria estable
title_short	Análisis crítico de un artículo: La terapia intensiva con atorvastatina tiene un beneficio marginal en pacientes con enfermedad coronaria estable
title_full	Análisis crítico de un artículo: La terapia intensiva con atorvastatina tiene un beneficio marginal en pacientes con enfermedad coronaria estable
title_fullStr	Análisis crítico de un artículo: La terapia intensiva con atorvastatina tiene un beneficio marginal en pacientes con enfermedad coronaria estable
title_full_unstemmed	Análisis crítico de un artículo: La terapia intensiva con atorvastatina tiene un beneficio marginal en pacientes con enfermedad coronaria estable
title_sort	análisis crítico de un artículo: la terapia intensiva con atorvastatina tiene un beneficio marginal en pacientes con enfermedad coronaria estable
publisher	Sociedad Médica de Santiago
publishDate	2006
url	http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872006000300020
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Análisis crítico de un artículo: La terapia intensiva con atorvastatina tiene un beneficio marginal en pacientes con enfermedad coronaria estable

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