Japanese patients with CAD benefit from high-intensity statin therapy (May 2018)

CVD의 2 차 예방을위한 고강도 스타틴 요법은 아시아 인구, 특히 일본인 환자에게 널리 사용되지는 않습니다.  잠정적인 이유는 아시아 인구에서 ①이 치료의 무작위 시험의 부재와 ②스타틴 치료법에 대한 반응이 인종, 특히 기준 위험 요소가 다른 집단 또는 CVD의 기저 위험이 낮은 집단에서 다를 수 있다는 우려 때문입니다.

REAL-CAD 연구는 stable coronary artery disease가 있는 13,054 명의 일본인 환자에게 피타바스타틴을 매일 4 또는 1 mg 씩 무작위 배정하였습니다. 등록 전 평균 LDL-C 수치는 93 mg / dL이었습니다. 3.9 년의 중간 추적 관찰 후, 달성된 LDL-C는 두 그룹에서 각각 76.6과 91.0 mg / dL이었습니다. 고용량 피타바스타틴으로 치료한 그룹은 심혈관 사망, 비치명적 심근 경색, 비치명적 허혈성 뇌졸중 또는 불안정 협심증의 주요 복합 종말점 위험이 낮았습니다(4.3 % 대 5.4 %, 위험 비 0.81, 95 % CI 0.69-0.95) . 부작용의 위험은  두 그룹 간에 차이는 없었습니다. 또한, 모든 원인 사망은 높은 강도의 피타바스타틴에서 감소했습니다(3.7 % 대 4.2 %, p = 0.03). 이 연구는 고강도 스타틴이 심혈관 사건을 줄이기 위해 저강도 스타틴보다 효과적이라는 개념을 지지합니다.

What Are the Clinical Implications? 
• The results of the REAL-CAD study confirmed that high-dose compared with low-dose pitavastatin can safely improve the prevention of cardiovascular events in Japanese patients with coronary artery disease, who commonly receive low-intensity statin therapy. 

• REAL-CAD is a practice-changing trial, suggesting that the administration of maximum tolerable doses of statins, within the range of local approval, would be the preferred statin strategy in patients with established coronary artery disease regardless of baseline low-density lipoprotein cholesterol levels.

참고문헌

1. UpToDate 2018.09.07
2. Circulation. 2018;137(19):1997.