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Early, aggressive lipid management in the treatment of acute coronary syndromes

Brian K Irons

Evaluation of: Cannon CP, Braunwald E, McCabe CH et al. Intensive versus moderate lipid lowering with statins after acute coronary syndromes. N. Engl. J. Med. 350(15), 1495–1504 (2004). The Pravastatin or Atorvastatin Evaluation and Infection Therapy (PROVE-IT) study has suggested that very early, aggressive therapy to reduce low-density lipoprotein levels beyond current recommendations (100 mg/dL) reduces cardiovascular morbidity and mortality in patients with acute coronary syndromes. PROVE-IT randomized subjects to either 40 mg of pravastatin or 80 mg of atorvastatin, daily. Atorvastatin therapy reduced the primary outcome (cardiovascular morbidity and mortality) by 16% compared with pravastatin during 2 years of follow-up. The PROVE-IT study adds valuable information to the medical literature in the acute treatment of acute coronary syndromes and suggests that the previous low-density lipoprotein goals for patients with acute coronary heart disease are not appropriate for all patients. The results of the PROVE-IT study were significant enough to lead to modifications of lipid guidelines. However, the PROVE-IT trial and subsequent alterations in guidelines have the potential for misinterpretation and misuse of high-dose statins. Based on the subgroup analysis of the study, acute coronary syndromes patients who have low-density lipoprotein concentrations greater than or equal to 125 mg/dL may benefit from early, high-dose statin therapy more than those with lower baseline low-density lipoprotein levels.