Comparison of preventive effect on cardiovascular events with different statins: The circle study

Abstract

Background: Although statins vary in their effectiveness in lowering low-density lipoprotein cholesterol (LDL-C)and increasing high-density lipoprotein cholesterol (HDL-C) levels, there is little evidence that the degree of thesechanges can explain cardiac risk reduction in Japan. Our objective was to compare the efficacy of statins onserum lipid levels and to explore the association between those changes and cardiac events in patients after percutaneouscoronary intervention (PCI).Methods and Results: The 743 consecutive patients who underwent PCI from 2001 to 2008 were retrospectivelyinvestigated. Treatment with either atorvastatin or pitavastatin significantly reduced LDL-C compared withpravastatin or no statin. In contrast, only pitavastatin treatment significantly increased HDL-C (13.4±22.9%, P=0.01vs. no statin). Each statin significantly prevented major adverse cardiac events (MACE) compared with no statin,and pitavastatin was the most effective of all. Multivariate-adjusted analysis revealed that percent changes ofboth LDL-C and HDL-C independently predicted the incidence of MACE (hazard ratio [HR]: 1.015; 95% confidenceinterval [CI]: 1.010-1.020, HR: 0.988; 95%CI: 0.981-0.996, respectively). This relationship was preservedin patients with a baseline HDL-C level ≤45 mg/dl, but not HDL-C level >45 mg/ml.Conclusions: The extent of changes in LDL-C and HDL-C with statin treatment would independently alter therisk of cardiac events in Japanese patients for secondary prevention. Statins with varying lipid-modifying abilitymight provide differing prognosis in patients after PCI. (Circ J 2011; 75: 1951-1959).