학술논문
Thrombotic Risk Stratification and Intensive Statin Therapy for Secondary Prevention of Coronary Artery Disease ― Insights From the REAL-CAD Study ―
Document Type
Journal Article
Author
Hiroki Shiomi; Hiroshi Iwata; Hirotoshi Watanabe; Hiroyuki Daida; Ichiro Sakuma; Katsumi Miyauchi; Kyohei Yamaji; Masahiro Natsuaki; Masunori Matsuzaki; Naritatsu Saito; Retsu Fujita; Ryozo Nagai; Satoru Suwa; Satoshi Iimuro; Takeshi Kimura; Takeshi Morimoto; Teruo Inoue; Yoshihisa Nakagawa; Yosuke Nishihata; Yukio Ozaki; Yutaka Furukawa; on behalf of the REAL-CAD Investigators
Source
Circulation Journal. 2022, 86(9):1416
Subject
Language
English
ISSN
1346-9843
1347-4820
1347-4820
Abstract
Methods and Results: The Randomized Evaluation of Aggressive or Moderate Lipid-Lowering Therapy with Pitavastatin in Coronary Artery Disease (REAL-CAD) study is a randomized trial comparing 4 mg and 1 mg pitavastatin in patients with CCS. This study categorized 12,413 patients into 3 strata according to the CREDO-Kyoto thrombotic risk score: low-risk (N=9,434; 4 mg: N=4,742, and 1 mg: N=4,692), intermediate-risk (N=2,415; 4 mg: N=1,188, and 1 mg: N=1,227); and high-risk (N=564; 4 mg: N=269, and 1 mg: N=295). The primary endpoint was a composite of cardiovascular death, non-fatal myocardial infarction, non-fatal ischemic stroke, or unstable angina. Cumulative 4-year incidence of the primary endpoint was significantly higher in the high-risk stratum than in the intermediate- and low-risk strata (11.0%, 6.3%, and 4.5%, P<0.0001). In the low-risk stratum, the cumulative 4-year incidence of the primary endpoint was significantly lower in the 4 mg than in the 1 mg group (4.0% and 4.9%, P=0.02), whereas in the intermediate- and high-risk strata, it was numerically lower in the 4 mg than in the 1 mg group. There was no significant treatment-by-subgroup interaction for the primary endpoint (P-interaction=0.77).