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Potent anti-ischaemic effects of statins in chronic stable angina: incremental benefit beyond lipid lowering?

Deanfield JE, Sellier P, Thaulow E, Bultas J, Yunis C, Shi H, Buch J, Beckerman B - Eur. Heart J. (2010)

Bottom Line: There was a comparable, highly significant decrease in TMI with amlodipine and atorvastatin, but no additional benefit for the combination.Adverse events were comparable among groups.Atorvastatin was as potent an anti-ischaemic agent as amlodipine.

View Article: PubMed Central - PubMed

Affiliation: Great Ormond Street Hospital, University College London, London, UK. j.deanfield@ich.ucl.ac.uk

ABSTRACT

Aims: The DoUble-blind Atorvastatin AmLodipine (DUAAL) trial investigated whether atorvastatin decreases ischaemia by a vascular benefit, independent of low-density lipoprotein cholesterol lowering, in patients with coronary artery disease (CAD), both alone and in combination with the traditional anti-anginal therapy, amlodipine.

Methods and results: Randomized, double-blind, parallel-group, multicountry trial (2 weeks run-in and 24 weeks active therapy) comparing three treatments: amlodipine, atorvastatin, and amlodipine + atorvastatin; in 311 patients (78% male; mean age 62 years) with stable angina (≥ 2 attacks/week), CAD history, ≥ 3 transient myocardial ischaemia (TMI) episodes, and/or ≥ 15 min ischaemia on 48 h ambulatory electrocardiographic (AECG) monitoring. Efficacy variables were change in TMI by AECG, exercise ischaemia, angina diary data, and inflammatory biomarkers at Week 26. There was a comparable, highly significant decrease in TMI with amlodipine and atorvastatin, but no additional benefit for the combination. More than 50% of patients became TMI-free in all three groups and this was accompanied by a comparable, marked reduction in angina and nitroglycerin consumption. High-sensitivity C-reactive protein fell by 40% in patients receiving atorvastatin but there was no change with amlodipine. Adverse events were comparable among groups.

Conclusion: Atorvastatin was as potent an anti-ischaemic agent as amlodipine. Future studies of combination therapies will be instructive.

Clinical trial registration information: National clinical trial number: NCT00159718, protocol number A0531031 listed on http://clinicaltrials.gov/.

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Related in: MedlinePlus

Median number of transient myocardial ischaemia episodes/week, recorded by ambulatory electrocardiographic 48 h monitoring. **P < 0.001 vs. baseline. TMI, transient myocardial ischaemia.
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EHQ133F3: Median number of transient myocardial ischaemia episodes/week, recorded by ambulatory electrocardiographic 48 h monitoring. **P < 0.001 vs. baseline. TMI, transient myocardial ischaemia.

Mentions: At Week 26, the median number of ischaemic episodes in all three groups decreased significantly (P < 0.001, within-treatment comparison) (Figure 3). There was no significant difference among the three treatment groups in the change from baseline to Week 26 in the number of ischaemic episodes (overall P = 0.922). Transient myocardial ischaemia episodes decreased by >66% in all cohorts, with >50% of patients becoming TMI-free at the final visit in all three groups (Figure 3). Additionally, the median duration of the TMI episodes decreased by >75% in all three groups. There were no differences in efficacy between the treatments, with virtual elimination of ischaemic events by Week 18; atorvastatin was as effective as amlodipine (Figure 3).


Potent anti-ischaemic effects of statins in chronic stable angina: incremental benefit beyond lipid lowering?

Deanfield JE, Sellier P, Thaulow E, Bultas J, Yunis C, Shi H, Buch J, Beckerman B - Eur. Heart J. (2010)

Median number of transient myocardial ischaemia episodes/week, recorded by ambulatory electrocardiographic 48 h monitoring. **P < 0.001 vs. baseline. TMI, transient myocardial ischaemia.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2966969&req=5

EHQ133F3: Median number of transient myocardial ischaemia episodes/week, recorded by ambulatory electrocardiographic 48 h monitoring. **P < 0.001 vs. baseline. TMI, transient myocardial ischaemia.
Mentions: At Week 26, the median number of ischaemic episodes in all three groups decreased significantly (P < 0.001, within-treatment comparison) (Figure 3). There was no significant difference among the three treatment groups in the change from baseline to Week 26 in the number of ischaemic episodes (overall P = 0.922). Transient myocardial ischaemia episodes decreased by >66% in all cohorts, with >50% of patients becoming TMI-free at the final visit in all three groups (Figure 3). Additionally, the median duration of the TMI episodes decreased by >75% in all three groups. There were no differences in efficacy between the treatments, with virtual elimination of ischaemic events by Week 18; atorvastatin was as effective as amlodipine (Figure 3).

Bottom Line: There was a comparable, highly significant decrease in TMI with amlodipine and atorvastatin, but no additional benefit for the combination.Adverse events were comparable among groups.Atorvastatin was as potent an anti-ischaemic agent as amlodipine.

View Article: PubMed Central - PubMed

Affiliation: Great Ormond Street Hospital, University College London, London, UK. j.deanfield@ich.ucl.ac.uk

ABSTRACT

Aims: The DoUble-blind Atorvastatin AmLodipine (DUAAL) trial investigated whether atorvastatin decreases ischaemia by a vascular benefit, independent of low-density lipoprotein cholesterol lowering, in patients with coronary artery disease (CAD), both alone and in combination with the traditional anti-anginal therapy, amlodipine.

Methods and results: Randomized, double-blind, parallel-group, multicountry trial (2 weeks run-in and 24 weeks active therapy) comparing three treatments: amlodipine, atorvastatin, and amlodipine + atorvastatin; in 311 patients (78% male; mean age 62 years) with stable angina (≥ 2 attacks/week), CAD history, ≥ 3 transient myocardial ischaemia (TMI) episodes, and/or ≥ 15 min ischaemia on 48 h ambulatory electrocardiographic (AECG) monitoring. Efficacy variables were change in TMI by AECG, exercise ischaemia, angina diary data, and inflammatory biomarkers at Week 26. There was a comparable, highly significant decrease in TMI with amlodipine and atorvastatin, but no additional benefit for the combination. More than 50% of patients became TMI-free in all three groups and this was accompanied by a comparable, marked reduction in angina and nitroglycerin consumption. High-sensitivity C-reactive protein fell by 40% in patients receiving atorvastatin but there was no change with amlodipine. Adverse events were comparable among groups.

Conclusion: Atorvastatin was as potent an anti-ischaemic agent as amlodipine. Future studies of combination therapies will be instructive.

Clinical trial registration information: National clinical trial number: NCT00159718, protocol number A0531031 listed on http://clinicaltrials.gov/.

Show MeSH
Related in: MedlinePlus