Clinical outcomes in managed-care patients with coronary heart disease treated aggressively in lipid-lowering disease management clinics: The alliance study

摘要: Objectives This study sought to determine if an aggressive, focused low-density lipoprotein cholesterol (LDL-C)-lowering strategy was superior usual care for coronary heart disease (CHD) patients enrolled in health maintenance organization or Veterans Administration settings. Background Statin therapy benefits are well established. No prospective, randomized studies have tested strategies optimize these a “real-world” setting. Methods A total of 2,442 CHD with hyperlipidemia were either aggressive treatment arm using atorvastatin and followed 51.5 months on average. Atorvastatin-group titrated LDL-C goals l80 mg/dl (2.1 mmol/l) maximum dose 80 mg/day. Usual-care received any deemed appropriate by their regular physicians. End point assessments complete 958 atorvastatin-group 941 usual-care patients. Partial occurred 259 the group 284 who did not four years participation because adverse events, withdrawn consent, follow-up loss. The primary efficacy parameter time first cardiovascular event. Results 289 (23.7%) compared 333 (27.7%) experienced outcome (hazard ratio, 0.83; 95% confidence interval 0.71 0.97, p = 0.02). reduction morbidity largely due fewer non-fatal myocardial infarctions (4.3% vs. 7.7%, 0.0002). Levels reduced more (34.3% 23.3%, l 0.0001) National Cholesterol Education Program (LDL-C l100 mg/dl) likely met at end-of-study visits (72.4% 40.0%) receiving those care. Conclusions An statin management outperformed clinic CHD.