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March 3, 2004

High-Intensity Statin Treatment for Coronary Heart Disease

JAMA. 2004;291(9):1132-1134. doi:10.1001/jama.291.9.1132

In this issue of THE JOURNAL, Nissen and colleagues1 report the findings of the Reversal of Atherosclerosis with Aggressive Lipid Lowering (REVERSAL) study, a clinical trial comparing the effects of 2 statins, pravastatin (40-mg dose) and atorvastatin (80-mg dose). The REVERSAL study is a first in 2 respects. First, it showed that a statin regimen using the most efficacious drug (atorvastatin) and dose available for lowering low-density lipoprotein cholesterol (LDL-C) when the trial began improved coronary atherosclerosis more than pravastatin, which represented a statin regimen that had been fully established to safely reduce cardiovascular disease and mortality.2-6 Second, the advantage of atorvastatin was demonstrated using an intravascular ultrasound examination of the coronary arteries, a technique that quantifies plaque by visualizing the coronary arterial intima. While this study is an important achievement, it is equally important to determine what it adds to current knowledge of lipid therapy in atherosclerotic cardiovascular disease and how it should affect clinical practice.

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