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Comparison of the effects of atorvastatin versus simvastatin on subclinical atherosclerosis in primary preventionas determined by electronbeam tomography

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Abstract

This study was designed to evaluate the effects of lipid-lowering therapy by atorvastatin versus simvastatin on calcified plaque progression, as determined by serial electron beam tomography (EBT), in primary prevention patients. In this observational study, serial EBT was performed before and after 1.2 years of atorvastatin (n = 103) and simavastatin therapy (n = 46); ∼50% of each group was on niacin as well, in similar doses. There were no differences in demographic parameters between the groups. Total, low-density lipoprotein (LDL), and non–high-density lipoprotein (HDL) cholesterol were significantly higher in the atorvastatin group before treatment. Before treatment, EBT calcium score and volume scores were 469 and 378, respectively, in the atorvastatin patients, and 388 and 307, respectively, in the simvastatin patients (p = NS, atorvastatin vs simvastatin). After treatment, there were no differences in any lipid or EBT values between the groups. Post-treatment total cholesterol and LDL cholesterol were 156 and 79 mg/dl, respectively, in the atorvastatin cohort and 154 and 76 mg/dl, respectively, in the simvastatin group (p = NS). Calcium score and volume progressed 10.8%/year and 8.5%/year, respectively, in the atorvastatin group, and 7.5%/year and 7.8%/year in the simvastatin group (p = NS, atorvastatin vs simvastatin). We conclude that aggressive treatment with atorvastatin and simvastatin in the primary prevention population, to similar lipid levels, is associated with equal progression of EBT-determined calcified plaque. This suggests that these hydroxymethylglutaryl coenzyme A reductase inhibitors exhibit a “class effect” with respect to progression of subclinical atherosclerosis.

Section snippets

Subjects

One hundred forty-nine consecutive asymptomatic patients with EBT evidence for subclinical atherosclerosis, who were treated with atorvastatin or simvastatin alone or in combination with niacin and who underwent repeat EBT evaluation, comprised the patient population. This was an observational study, not a randomized trial; serial EBT evaluation and lipid-lowering agents and doses employed were chosen by the treating physicians based on practice patterns, and not according to criteria set by

Demographics (table 1)

There were no differences in risk factor distribution between the 2 groups. Men predominated and a family history of premature CAD was frequently noted (∼60%). Hypertension was considerably more common than smoking or diabetes. The atorvastatin dose was lower than that of simvastatin, reflecting their difference in potency. Similar percentages of patients were on niacin, in almost identical doses. The interscan interval was 1.2 years for atorvastatin and simvastatin patients.

Lipid and EBT values (table 1)

Before treatment,

Discussion

This study demonstrates that aggressive treatment with atorvastatin and simvastatin is associated with similar outcomes as measured by calcified plaque progression in a primary prevention population. This suggests that, in doses producing similar improvements in lipid profiles, they manifest a class effect with respect to progression of subclinical atherosclerosis, rather than a property unique to a particular drug.

References (16)

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