What is the clinical evidence from this study?

Study design: RCT. Population: Patients meeting NCEP II criteria for lipid-lowering therapy (n=161). Intervention: Atorvastatin vs. Pravastatin 40 mg/d. Primary outcome: Change in carotid intima-media thickness (CIMT) (p=0.03).

What question did this study set out to answer?

To assess whether marked LDL cholesterol reduction well below 100 mg/dL using high-potency atorvastatin regresses carotid atherosclerosis compared to standard pravastatin therapy.

October 15, 2002CirculationOpen Access

ARBITER: Arterial Biology for the Investigation of the Treatment Effects of Reducing Cholesterol

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Key result

Atorvastatin 80 mg/d induced progressive carotid intima-media thickness regression over 12 months (-0.034 mm) compared to stable thickness with pravastatin 40 mg/d (0.025 mm; P=0.03).

Why the study?

Does atorvastatin 80 mg/d improve carotid intima-media thickness compared to pravastatin 40 mg/d in patients requiring lipid-lowering therapy?

Population

161 patients meeting National Cholesterol Education Program II criteria for lipid-lowering therapy, mean age…

Comparison

Atorvastatin 80 mg/d for 12 months vs Pravastatin 40 mg/d for 12 months

Design

RCT, randomized, blinded assessments

Follow-up

12 months

Authors

ATAllen J. TaylorCardiac Imaging SKSteven M. KentNavicent Health PFPatrick FlahertyAmherst College

Discussion

Member takes

Implication

High-dose atorvastatin should be prioritized for carotid atherosclerosis; confirms intensive statin superiority over moderate regimens in RCTs.

Key Points

To assess whether marked LDL cholesterol reduction well below 100 mg/dL using high-potency atorvastatin regresses carotid atherosclerosis compared to standard pravastatin therapy.
Single-center, randomized clinical trial enrolling 161 patients (mean age 60 years; 71.4% male; 46% with known cardiovascular disease) meeting NCEP II criteria.
Participants received either atorvastatin 80 mg/day (n=79) or pravastatin 40 mg/day (n=82) for 12 months.
Blinded, serial ultrasound assessments measured the far wall of the distal common carotid artery to evaluate change in carotid intima-media thickness.
Atorvastatin achieved greater LDL cholesterol reduction at 12 months than pravastatin (76 ± 23 mg/dL [-48.5%] vs 110 ± 30 mg/dL [-27.2%]; P < 0.001).
Atorvastatin produced significant regression in carotid intima-media thickness (-0.034 ± 0.021 mm), whereas thickness remained stable or slightly progressed with pravastatin (0.025 ± 0.017 mm; P = 0.03).

Study Design

Type

RCT (n=161)

Blinding

Blinded

Randomization

Randomized

Multicenter

Structured PICO

Does atorvastatin 80 mg/d improve carotid intima-media thickness compared to pravastatin 40 mg/d in patients requiring lipid-lowering therapy?

Population

161 patients meeting National Cholesterol Education Program (NCEP) II criteria for lipid-lowering therapy, mean age 60 years, 71.4% male, 46% with known cardiovascular disease.

Intervention

Atorvastatin 80 mg/d for 12 months

Comparator

Pravastatin 40 mg/d for 12 months

Outcome

Change in carotid intima-media thickness (CIMT) assessed by blinded, serial assessments of the far wall of the distal common carotid artery over 12 monthssurrogate

Main Result

Absolute Event Rate: -0.034% vs 0.025%

p-value: p=0.03

Intensive lipid-lowering with atorvastatin 80 mg/d significantly regresses carotid intima-media thickness at 1 year compared to moderate-intensity pravastatin 40 mg/d.

Cite This Study

Taylor et al. (2002) conducted an RCT in Patients meeting NCEP II criteria for lipid-lowering therapy (n=161). Atorvastatin vs. Pravastatin 40 mg/d was evaluated on Change in carotid intima-media thickness (CIMT) (p=0.03). Atorvastatin 80 mg/d induced progressive carotid intima-media thickness regression over 12 months (-0.034 mm) compared to stable thickness with pravastatin 40 mg/d (0.025 mm; P=0.03).

synapsesocial.com/papers/6a09c6bfb0d552aa8b45e216 https://doi.org/10.1161/01.cir.0000034508.55617.65

Topics

PCSK9 inhibitors Statin therapy

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Implication

High-dose atorvastatin should be prioritized for carotid atherosclerosis; confirms intensive statin superiority over moderate regimens in RCTs.

ARBITER: Arterial Biology for the Investigation of the Treatment Effects of Reducing Cholesterol

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Cite This Study

Topics

ARBITER: Arterial Biology for the Investigation of the Treatment Effects of Reducing Cholesterol

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Cite This Study

Also Consider

Topics

Also Consider