Thrombotic Risk Stratification and Intensive Statin Therapy for Secondary Prevention of Coronary Artery Disease-Insights From the REAL-CAD Study

Masahiro Natsuaki, Takeshi Morimoto, Satoshi Iimuro, Retsu Fujita, Hiroshi Iwata, Katsumi Miyauchi, Teruo Inoue, Yoshihisa Nakagawa, Yosuke Nishihata, Hiroyuki Daida, Yukio Ozaki, Satoru Suwa, Ichiro Sakuma, Yutaka Furukawa, Hiroki Shiomi, Hirotoshi Watanabe, Kyohei Yamaji, Naritatsu Saito, Masunori Matsuzaki, Ryozo NagaiTakeshi Kimura

Research output: Contribution to journalArticlepeer-review

Abstract

Background: It is unknown whether beneficial effects of higher-dose statins on cardiovascular events are different according to the thrombotic risk in patients with chronic coronary syndrome (CCS). Methods and Results: The Randomized Evaluation of Aggressive or Moderate Lipid-Lowering Therapy with Pitavastatin in Coronary Artery Disease (REAL-CAD) study is a randomized trial comparing 4 mg and 1 mg pitavastatin in patients with CCS. This study categorized 12,413 patients into 3 strata according to the CREDO-Kyoto thrombotic risk score: low-risk (N=9,434; 4 mg: N=4,742, and 1 mg: N=4,692), intermediate-risk (N=2,415; 4 mg: N=1,188, and 1 mg: N=1,227); and high-risk (N=564; 4 mg: N=269, and 1 mg: N=295). The primary endpoint was a composite of cardiovascular death, non-fatal myocardial infarction, non-fatal ischemic stroke, or unstable angina. Cumulative 4-year incidence of the primary endpoint was significantly higher in the high-risk stratum than in the intermediate- and low-risk strata (11.0%, 6.3%, and 4.5%, P<0.0001). In the low-risk stratum, the cumulative 4-year incidence of the primary endpoint was significantly lower in the 4 mg than in the 1 mg group (4.0% and 4.9%, P=0.02), whereas in the intermediateand high-risk strata, it was numerically lower in the 4 mg than in the 1 mg group. There was no significant treatment-by-subgroup interaction for the primary endpoint (P-interaction=0.77). Conclusions: High-dose pitavastatin therapy compared with low-dose pitavastatin therapy was associated with a trend toward lowering the risk for cardiovascular events irrespective of the thrombotic risk in patients with CCS.

Original languageEnglish
Pages (from-to)1416-1427
Number of pages12
JournalCirculation Journal
Volume86
Issue number9
DOIs
Publication statusPublished - 2022

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

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