What is the clinical evidence from this study?

Study design: RCT. Population: coronary heart disease (n=1600). Intervention: Structured care with atorvastatin vs. Usual care. Primary outcome: Cardiovascular events (composite of death, myocardial infarction, revascularization, unstable angina, heart failure, and stroke) in the highest age quartile (elderly) (ARR 16.5%, p=<0.0001).

January 1, 2013Archives of Medical ScienceOpen Access

Statins and cardiovascular outcomes in elderly and younger patients with coronary artery disease: a post hoc analysis of the GREACE study

Q: What are the key findings of this study?

Structured care with atorvastatin targeted to lipid goals reduced absolute cardiovascular events by 16.5% in elderly patients compared to usual care, demonstrating greater absolute and relative risk reduction than in younger patients.

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Why the study?

Does structured care with atorvastatin to achieve lipid goals reduce cardiovascular events more in elderly compared to younger patients with coronary artery disease?

Study Design

Type

RCT (n=1,600)

Blinding

open-label

Randomization

randomized

Multicenter

Structured PICO

Does structured care with atorvastatin to achieve lipid goals reduce cardiovascular events more in elderly compared to younger patients with coronary artery disease?

Population

1,600 men and women aged < 75 years with established coronary heart disease and dyslipidemia, followed for a mean of 3 years.

Intervention

Structured care with atorvastatin (starting dose 10 mg/day, titrated up to 80 mg/day at 6-week intervals to reach NCEP LDL-C goal <100 mg/dl) followed up by university clinic.

Comparator

Usual care followed up by specialists or general practitioners outside the hospital (only 14% received hypolipidaemic drugs, 12% on statins).

Outcome

Absolute and relative CVD event (composite of death, myocardial infarction, revascularization, unstable angina, heart failure and stroke) risk reduction in age quartiles.composite

Main Result

Absolute Risk Reduction: 16.5

Absolute Event Rate: 11% vs 27.5%

Absolute Risk Reduction: 16.5%

Number Needed to Treat: 6.1

p-value: p=<0.0001

Limitations

This is a post hoc analysis.
The number of patients included in each quartile was relatively small and did not allow multivariate analysis involving backward stepwise logistic regression.
Only 22% of the study population were women and fewer were included in the lower age quartiles.
Lack of statistical power due to the relatively small number of patients in each age quartile

Discussion

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Implication

Supports structured atorvastatin to lipid goals in elderly CAD patients; extends evidence of amplified benefit versus younger adults.

Cite This Study

Athyros et al. (2013) conducted an RCT in coronary heart disease (n=1,600). Structured care with atorvastatin vs. Usual care was evaluated on Cardiovascular events (composite of death, myocardial infarction, revascularization, unstable angina, heart failure, and stroke) in the highest age quartile (elderly) (ARR 16.5%, p=<0.0001). Structured care with atorvastatin targeted to lipid goals reduced absolute cardiovascular events by 16.5% in elderly patients compared to usual care, demonstrating greater absolute and relative risk reduction than in younger patients.

synapsesocial.com/papers/6a903e96fecd36257390a3bc https://doi.org/10.5114/aoms.2013.35424

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Statins and cardiovascular outcomes in elderly and younger patients with coronary artery disease: a post hoc analysis of the GREACE study

Study Design

Structured PICO

Main Result

Limitations

Discussion

Implication

Cite This Study

Statins and cardiovascular outcomes in elderly and younger patients with coronary artery disease: a post hoc analysis of the GREACE study

Study Design

Structured PICO

Main Result

Limitations

Discussion

Implication

Cite This Study

Also Consider

Also Consider