Intensive lipid-lowering therapy in coronary artery disease: implications of the REVERSAL and PROVE-IT trials.

Overview

Current international guidelines recommend that the goal of treatment with lipid-lowering therapy in patients with established coronary artery disease (CAD) should be a low-density lipoprotein cholesterol level of < 100 mg/dl. The question that remains to be answered is whether more aggressive lowering of low-density lipoprotein cholesterol levels below this target offers additional benefit and whether it can be tolerated. Two recently published related studies addressed this question by comparing intensive lipid lowering with atorvastatin (Lipitor, Pfizer) 80 mg/day with a moderate lipid-lowering regimen of pravastatin (Pravachol, Bristol-Myers Squibb) 40 mg/day. The first study, the Reversing Atherosclerosis with Aggressive Lipid Lowering (REVERSAL) compared the effect of the two regimens on coronary artery atheroma burden and progression using intravascular ultrasound in patients with symptomatic CAD. The second study, the Pravastatin or Atorvastatin Evaluation and Infection Therapy (PROVE-IT) was a clinical outcome trial in patients recently hospitalised with acute coronary syndromes. This article reviews the implications of these two studies in the management of patients with CAD. In addition, other ongoing trials and future directions are explored.