http://www.theheart.org/web_slides/1143733.do A study on pravastatin or atorvastatin evaluation and infection therapy (PROVE-IT) with 4162 patients hospitalized for acute MI and unstable angina

1. PROVE-IT (Pravastatin or Atorvastatin
Evaluation and Infection Therapy)

2. PROVE-IT (Pravastatin or Atorvastatin Evaluation and
Infection Therapy)
CP Cannon (Brigham and Women’s Hospital, Boston, MA)
American College of Cardiology 2004 Scientific Sessions
• Population and treatment:
4162 patients hospitalized for acute MI and unstable angina with TC <240
mg/dL within 24 hours of ACS onset. Patients receiving long-term statin
therapy at time of index ACS were included if TC <200 mg/dL at screening
Randomized to pravastatin 40 mg/d or atorvastatin 80 mg/d for 24 months
• Outcomes:
Primary end point: composite of all-cause mortality, MI, documented
unstable angina requiring hospitalization, revascularization requiring PCI or
CABG, and stroke
Secondary end points: CHD death, MI, or revascularization; CHD death/MI;
and individual components of the primary end point
TC=total cholesterol

3. PROVE-IT: Results
• Pravastatin failed to meet the criteria for equivalence
Results at 24 months
Measure Pravastatin 40 mg (n=1973) Atorvastatin 80 mg (n=2003) Relative risk reduction p
Final LDL cholesterol, 95 (79–113) 62 (50–79) – <0.001
mg/dL (IQR)
Primary end point (%) 26.3 22.4 16 0.005
Secondary end points
CHD death, nonfatal MI, 22.3 19.7 14 0.029
or revascularization (%)
All-cause mortality (%) 3.2 2.2 28 0.07
Death/nonfatal MI (%) 10.0 8.3 18 0.06
Unstable angina (%) 5.1 3.8 29 0.02
Revascularization (%) 18.8 16.3 14 0.04

4. PROVE-IT: Commentary*
"The take-home message from this study is that it is probably a good idea to be
very aggressive with LDL lowering early on."
- Dr Roger Blumenthal
"We want to make sure that patients receive the optimal benefits of this class of
drugs proven to reduce mortality, MI, and other cardiac end points. I think we've
seen that titrating upward does not always happen."
- Dr Christopher P Cannon
"These results should be a huge surprise, because the study, in my opinion, was
carefully and cleverly designed to show no difference."
- Dr Steven Nissen
*All comments from A "sea change" in the prevention of CVD: Experts discuss the PROVE-IT trial
(http://www.theheart.org/article/120261.do)

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