GREACE (GREek Atorvastatin Coronary-heart-disease Evaluation) study

The study was undertaken within two settings - a specialist unit treating to the US National Cholesterol Education Program (NCEP) guideline low density lipoprotein cholesterol (LDL-C) of < 2.6 mmol/L, compared with 'usual' care.

• eligibility criteria - these included previous myocardial infarction or > 70% stenosis of at least one coronary artery, < 75 years of age, LDL-C of > 2.6 mmol/L and triglycerides < 4.5 mmol/L
• 1,600 patients were recruited to the study - these patients were randomly allocated to receive either atorvastatin at the Hippocration Hospital in Thessaloniki, Greece, or 'usual' care outside the hospital for a mean follow-up of three years
• patients receiving atorvastatin had their dose titrated until they reached target LDL-C of < 2.6mmol/L.
  • 82% of the atorvastatin group were treated to target on atorvastatin 20mg per day
  • there was a 98% compliance in the atorvastatin group
• in the 'usual' treatment group
  • 26% of patients were prescribed lipid lowering therapy - however only 14% were treated throughout the study
  • atorvastatin was prescribed for 3% of the 'usual' treatment group
• results:
  • in the atorvastatin group
    • 95% reached the NCEP target of LDL-C (compared with 0% of patients receiving 'usual' care)
    • 97% reached the non-HDL-C target of 3.4 mmol/L (compared with 3% of patients receiving 'usual' care
    • the reduction in recurrent CHD or death in the atorvastatin group was highly significant (p<0.0001) with 96 events compared with 196 in the 'usual' care group
    • the atorvastatin group showed significant reductions of 47% in CHD mortality, 43% in total mortality , between 50-59% in other coronary events and 47% reduction in stroke. Subgroup analysis of women, elderly patients, patients with unstable angina, hypertension, diabetes, revascularisation and congestive heart failure were also higly significant
    • this statin reduced total chlesterol by 36%, LDL-C by 46%, triglycerides by 31%, and non-high-density lipoprotein cholesterol (non-HDL-C) by 44%, while it increased HDL-C by 7%; all these changes were significant
    • withdrawal of patients because of side-effects from the atorvastatin group was low (0.75%) and similar to that of the 'usual' care group (0.4%)
• CONCLUSIONS: Long-term treatment of CHD patients with atorvastatin to achieve NCEP lipid targets significantly reduces total and coronary mortality, coronary morbidity and stroke, in comparison to patients receiving 'usual' medical care

Reference:

1. Athyros V et al. Treatment with Atorvastatin to the National Cholesterol Education Program Goal Versus 'Usual' Care in Secondary Coronary Heart Disease Prevention. The GREek Atorvastatin and Coronary-heart-disease evaluation (GREACE) Study. Curr Med Res Opin 2002;18:220-8.