Impact of the Pravastatin or Atorvastatin Evaluation and Infection Therapy-Thrombolysis in Myocardial Infarction 22/reversal of atherosclerosis with aggressive lipid lowering trials on trends in intensive versus moderate statin therapy in Ontario, Canada

Background - In March 2004, the Reversal of Atherosclerosis With Aggressive Lipid Lowering ( REVERSAL) trial demonstrated that intensive lipid- lowering therapy ( atorvastatin 80 mg/ d) reduced progression of coronary atherosclerosis compared with moderate lipid- lowering therapy ( pravastatin 40 mg/ d). The following month, the Pravastatin or Atorvastatin Evaluation and Infection Therapy - Thrombolysis In Myocardial Infarction 22 ( PROVE IT - TIMI 22) study demonstrated the superiority of intensive ( atorvastatin 80 mg/ d) versus moderate ( pravastatin 40 mg/ d) lipid- lowering therapy for reducing death or cardiovascular events in patients suffering from an acute coronary syndrome. We sought to determine the impact of these 2 trials on trends in intensive versus moderate statin therapy in Ontario, Canada. Methods and Results - This is a retrospective time- series analysis of statin prescribing between June 1997 and September 2004 in Ontario, Canada, for all residents age 65 years and older. The publication of the PROVE IT - TIMI 22 and REVERSAL trials was associated with a sustained and statistically significant increase in the number of prescriptions dispensed for atorvastatin 80 mg ( range, 272 to 635 additional prescriptions per month), whereas the number of prescriptions filled for pravastatin 40 mg did not change. Similarly, it resulted in a temporal increase in the relative market share of atorvastatin at a dose of 80 mg versus that of atorvastatin at a dose of 40 mg. However, the proportion of simvastatin prescriptions for 80 mg relative to 40 mg did not change over time, implying a drug- specific effect rather than a class effect in prescribing practice. Conclusions - The publication of the PROVE IT - TIMI 22 and REVERSAL trials resulted in a significant sustained increase in the use of intensive compared with moderate statin therapy. This shift was evident primarily in an increased use of high- dose atorvastatin and did not appear to be generalizable to other statins.