Higher statin doses achieve additional benefits.
For people with
coronary heart disease (CHD), practice guidelines recommend reducing low-density
lipoprotein (LDL) levels to below 100 mg/dL and state that further reduction to
below 70 mg/dL is reasonable. In a secondary analysis of a manufacturer-funded
randomized trial, investigators studied patients with CHD (age 
65) who had achieved LDL cholesterol
levels below 130 mg/dL after receiving 10 mg of atorvastatin daily for 8 weeks,
who were then randomized to receive either 10 mg or 80 mg of atorvastatin daily.
At 12 weeks, mean LDL levels were 72 mg/dL for patients who received 80 mg and
97 mg/dL for those who continued on 10 mg.
During a median of 4.9 years, the high-dose group had significantly lower risk than the low-dose group (10.3% vs. 12.6%) for a major cardiovascular event (CHD death; nonfatal, nonprocedure-related myocardial infarction; resuscitated cardiac arrest; or stroke). Treatment-related adverse events were more common in the high-dose group (8.3% vs. 5.2%).
Comment: The study design precludes knowing whether the benefits achieved resulted from the higher dose of the drug or the lower cholesterol levels achieved. Nonetheless, the authors conclude that their findings support the recommendations of several practice guidelines to lower LDL cholesterol levels to below 100 mg/dL in people with CHD.
— Richard Saitz, MD, MPH, FACP, FASAM
Published in Journal Watch General Medicine July 26, 2007
Wenger NK et al. Outcomes of using high- or low-dose atorvastatin in patients 65 years of age or older with stable coronary heart disease. Ann Intern Med 2007 Jul 3; 147:1-9.