Author(s) |
(a) Isaacsohn JL, Davidson MH, Hunninghake D, Singer R, McLain R, Black DM
(b) Koren MJ, Hunninghake DB
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Title(s) |
(a) Aggressive Lipid-Lowering Initiation Abates New Cardiac Events (ALLIANCE) – rationale and design of atorvastatin versus usual care in hypercholesterolemic patients with coronary artery disease (b) Clinical outcomes in managed-care patients with coronary heart disease treated aggressively in lipid-lowering disease management clinics. The ALLIANCE study |
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Reference(s) |
(a) Am J Cardiol 2000;86:250–2 (b) J Am Coll Cardiol 2004;44:1772–9 |
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Disease |
Coronary heart disease, hyperlipidaemia |
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Purpose |
To compare an aggressive LDL cholesterol-lowering strategy vs usual care for hyperlipidaemia in patients with coronary heart disease and hyperlipidaemia |
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Study design |
Randomised, open |
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Follow-up |
Median 54.3 months (mean 51.5 months) |
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Patients |
2442 patients (1217 atorvastatin, 1225 usual care), aged > 18 years, with history of AMI, PTCA, CABG or unstable angina, and LDL cholesterol 110–200 mg/dl if taking lipid-lowering medication or 130–250 mg/dl if not taking lipid-lowering medication |
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Treatment regimen |
Atorvastatin, 10–80 mg/day to target LDL cholesterol < 80 mg/dl, or usual care for hyperlipidaemia, including diet, behaviour modification and/or lipid-lowering medication |
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Concomitant therapy |
In the atorvastatin group, no lipid-lowering medication other than atorvastatin was permitted. In the usual-care group, atorvastatin could be added at the discretion of the physician |
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Results |
The primary composite endpoint of cardiac death, nonfatal MI, resuscitated cardiac arrest, cardiac revascularisation or unstable angina requiring hospitalisation occurred in 23.7% of patients treated with atorvastatin and 27.7% of patients treated with usual care (hazard ratio 0.83, 95% CI 0.71–0.97; p = 0.02). The NCEP goal of LDL cholesterol < 100 mg/dl was achieved by 72.4% of patients in the atorvastatin group compared to 40.0% of those receiving usual care (p < 0.001) |
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Comments |
The results of a post hoc analysis in patients with/without chronic kidney disease have been published in Am J Kidney Dis 2009;53:741–50. Data from a subgroup of patients aged ≥ 65 years have been published in Clin Cardiol 2009;32:256–63 |
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