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Australian Journal of Pharmacy : November 2006
cover story AN AJP/PFIZER ADVERTORIAL Driving down lipid targets with the power of Lipitor Evidence of the cardiovascular health benefits which accrue when cholesterol levels are aggressively lowered with Lipitor 80mg was among recent research reviewed by the Pharmaceutical Benefits Advisory Committee that led to increasing access to PBS-subsidised cholesterol-lowering medicines P EOPLE at risk of heart disease and stroke now have increased access to cholesterol-lowering medicines through the Pharmaceutical Benefits Scheme (PBS) due to the recent extension of eligibility criteria—a decision which will mean approximately 250,000 more patients become eligible for the PBS subsidy.1 Those with a strong family history of cardiovascular disease or certain complications of diabetes, and patients who already have cardiovascular disease will now qualify for increased subsidised access to statins and other cholesterol-lowering medicines. These high-risk patients are now able to commence cholesterol-lowering therapy irrespective of existing cholesterol levels, although all patients are expected to maintain good diet in addition to cholesterol.2 The decision followed a review by the Pharmaceutical Benefits Advisory Committee (PBAC) of evidence surrounding the positive impact that prolonged and aggressive cholesterol- lowering treatment has on cardiovascular health. This review included the landmark study, Treating to New Targets (TNT), which demonstrated the significant clinical benefit of intensive lipid-lowering therapy with 80mg of atorvastatin (Lipitor) per day in patients with stable coronary heart disease compared to 10mg of atorvastatin.3 20 ? THE AUSTRALIAN JOURNAL OF PHARMACY VOL.86 NOVEMBER 2006 Aggressive lipid-lowering with Lipitor 80mg In this study,3 patients with clinically evident coronary heart disease and low-density lipoprotein (LDL) of less than 3.4mmol/L were randomly assigned to double-blind therapy and received either 10mg or 80mg of atorvastatin per day. The mean LDL cholesterol level for those receiving 80mg was 2mmol/L and 2.6mmol/L for those receiving 10mg. The patients were followed for a median of 4.9 years and the primary end point was the occurrence of a first major cardiovascular event. This occurred in 8.7 per cent of patients receiving 80mg atorvastatin and 10.9 per cent of those receiving 10mg, representing an absolute reduction in the rate of major cardiovascular events of 2.2 per cent and a 22 per cent relative reduction in risk (hazard ratio, 0.78;95 per cent confidence interval, 0.69 to 0.89; P<0.001). The authors wrote: ‘If these results were extrapolated to clinical practice, the use of an 80mg dose of atorvastatin to reduce LDL cholesterol levels from a baseline of [2.6mmol/L] to [2.0mmol/L] in 1,000 patients with stable coronary heart disease would prevent 34 major cardiovascular events over a period of five years; in other words, approximately 30 patients would need to be treated to prevent one event.’ The authors also stated that the trial data ‘confirm and