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

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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
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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.

Last reviewed 04/2020