Effects of Intensive Versus Moderate Lipid-Lowering Therapy on Myocardial Ischemia in Older Patients With Coronary Heart Disease: Results of the Study Assessing Goals in the Elderly (SAGE)
Abstract
Background— Clinical trials have demonstrated that, compared with placebo, intensive statin therapy reduces ischemia in patients with acute coronary syndromes and in patients with stable coronary artery disease. However, no studies to date have assessed intensive versus moderate statin therapy in older patients with stable coronary syndromes. Methods and Results— A total of 893 ambulatory coronary artery disease patients (30% women) 65 to 85 years of age with ≥1 episode of myocardial ischemia that lasted ≥3 minutes during 48-hour ambulatory ECG at screening were randomized to atorvastatin 80 mg/d or pravastatin 40 mg/d and followed up for 12 months. The primary efficacy parameter (absolute change from baseline in total duration of ischemia at month 12) was significantly reduced in both groups at month 3 and month 12 (both P <0.001 for each treatment group) with no significant difference between the treatment groups. Atorvastatin-treated patients experienced greater low-density lipoprotein cholesterol reductions than did pravastatin-treated patients, a trend toward fewer major acute cardiovascular events (hazard ratio, 0.71; 95% confidence interval, 0.46, 1.09; P =0.114), and a significantly greater reduction in all-cause death (hazard ratio, 0.33; 95% confidence interval, 0.13, 0.83; P =0.014). Conclusions— Compared with moderate pravastatin therapy, intensive atorvastatin therapy was associated with reductions in cholesterol, major acute cardiovascular events, and death in addition to the reductions in ischemia observed with both therapies. The contrast between the therapies’ differing efficacy for major acute cardiovascular events and death and their nonsignificant difference in efficacy for reduction of ischemia suggests that low-density lipoprotein cholesterol–lowering thresholds for ischemia and major acute cardiovascular events may differ. The Study Assessing Goals in the Elderly (SAGE) demonstrates that older men and women with coronary artery disease benefit from intensive statin therapy.
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In the SAGE trial, atorvastatin 80 mg compared with pravastatin 40 mg in patients aged 65-83 with stable CAD was associated with lower all-cause mortality (HR 0.33) and a nonsignificant trend toward fewer major CAD events.
“The atorvastatin group had a lower all-cause mortality (HR 0.33) and a nonsignificant trend towards reduction in major CAD events.”
From 2016 ESC/EAS Guidelines for the Management of Dyslipidaemias (2016) · cites this paper as [331]
In the SAGE trial of 893 patients 65-83 years of age with stable coronary artery disease, atorvastatin 80 mg was associated with lower all-cause mortality (HR 0.33) and a non-significant trend toward reduction in major coronary artery disease events compared with pravastatin 40 mg.
“In the Studies Assessing Goals in the Elderly (SAGE) trial, 893 patients 65e83 years of age with stable CAD were recruited to treatment with atorvastatin 80 mg or pravastatin 40 mg.331 The atorvastatin group had a lower all-cause mortality (HR 0.33) and a non-significant trend towards reduction in major CAD events.”
From 2016 ESC/EAS Guidelines for the Management of Dyslipidaemias (2016) · cites this paper as [331]
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- Authors
- Deedwania, P., Stone, P. H., Bairey Merz, C. N., Cosin-Aguilar, J., Koylan, N., Luo, D., Ouyang, P., Piotrowicz, R., Schenck-Gustafsson, K., Sellier, P., Stein, J. H., Thompson, P. L., & Tzivoni, D.
- Affiliations
- Cedars-Sinai Medical Center (US)
- From the UCSF School of Medicine, San Francisco, and Veterans Administration Central California Healthcare System (VACCHCS), Fresno, Calif (P.D.); the Brigham and Women’s Hospital (P.H.S.), Boston, Mass; the Cedars-Sinai Medical Center and the David Geffen School of Medicine at UCLA (C.N.B.M.), Los Angeles, Calif; the Hospital La Fe. Centro de Investigacion (J.C.-A.), Valencia, Spain; the Istanbul University (N.K.), Istanbul Faculty of Medicine, Istanbul, Turkey; Pfizer Inc. (D.L.), New York, NY;...
- ORCID
- Venue
- Circulation
- Published
- 2007-02-13
- Volume
- 115
- Issue
- 6
- Pages
- 700-707
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- OpenAlex
- W1998391689
- Cited by
- 236
- References
- 23
- Citations by year
- 2026: 4 · 2025: 1 · 2024: 7 · 2023: 5 · 2022: 6 · 2021: 6 · 2020: 8 · 2019: 15 · 2018: 7 · 2017: 7 · 2016: 11 · 2015: 16 · 2014: 16 · 2013: 26 · 2012: 17
- FWCI
- 19.97
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Circulation (publishedVersion)
- PubMed (publishedVersion)
- UWA Profiles and Research Repository (UWA) (submittedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Acute Myocardial Infarction Research
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Cancer Research › Cancer, Lipids, and Metabolism
- Keywords
- high-intensity statin therapy, atorvastatin, pravastatin, myocardial ischemia, coronary artery disease, elderly patients, LDL cholesterol lowering, all-cause mortality, Holter monitoring
- MeSH terms
- Atorvastatin, Aged, Aged, 80 and over, Anticholesteremic Agents, Coronary Disease, Female, Heptanoic Acids, Humans, Cholesterol, HDL, Cholesterol, LDL, Pyrroles, Sex Characteristics, Pravastatin, Myocardial Ischemia, Hydroxymethylglutaryl-CoA Reductase Inhibitors
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