TY - JOUR
T1 - Thrombotic Risk Stratification and Intensive Statin Therapy for Secondary Prevention of Coronary Artery Disease-Insights From the REAL-CAD Study
AU - Natsuaki, Masahiro
AU - Morimoto, Takeshi
AU - Iimuro, Satoshi
AU - Fujita, Retsu
AU - Iwata, Hiroshi
AU - Miyauchi, Katsumi
AU - Inoue, Teruo
AU - Nakagawa, Yoshihisa
AU - Nishihata, Yosuke
AU - Daida, Hiroyuki
AU - Ozaki, Yukio
AU - Suwa, Satoru
AU - Sakuma, Ichiro
AU - Furukawa, Yutaka
AU - Shiomi, Hiroki
AU - Watanabe, Hirotoshi
AU - Yamaji, Kyohei
AU - Saito, Naritatsu
AU - Matsuzaki, Masunori
AU - Nagai, Ryozo
AU - Kimura, Takeshi
N1 - Publisher Copyright:
© 2022 Japanese Circulation Society. All rights reserved.
PY - 2022
Y1 - 2022
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=85136518536&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85136518536&partnerID=8YFLogxK
U2 - 10.1253/circj.CJ-22-0315
DO - 10.1253/circj.CJ-22-0315
M3 - Article
C2 - 35934778
AN - SCOPUS:85136518536
SN - 1346-9843
VL - 86
SP - 1416
EP - 1427
JO - Circulation Journal
JF - Circulation Journal
IS - 9
ER -