Pfizer IT Club
Session 1: 4th Feb 2002 – Referencing and Word Modules
Cardiovascular disease is the single largest cause of death in Ireland. It accounts for
43% of all deaths. Elevated total cholesterol, LDL cholesterol and triglycerides along
with hypertension are among the factors which alter the risk of cardiovascular disease.
These risk factors are modifiable and Pfizer produces two excellent agents for their
control - Lipitor and Cardura XL.
Lipitor is the worlds number 1 agent at reducing both toatl cholesterol, LDL-C and
triglycerides. It allows you to simply achieve your lipid lowering goals for many of
your patients. 95% of patients on Lipitor will achieve their target goal(REF 1) of
5mmol/L for TC and 3mmol/L for LDL-C. 8 out of 10 patients will be controlled with
the 10mg starting dose(REF 2). Lipitor is the most efficacious statin (ref 3,4)(Fig 1),
while still being the most cost-effective at reducing LDL-cholesterol (Table 1).
Lipitor’s secondary prevention data, the MIRACL study provides the first data on the
effect of lipid-lowering therapy with a statin in patients with unstable coronary heart
disease directly following an acute coronary event. Early treatment with atorvastatin
80mg/d reduced recurrent ischaemic events, primarily recurrent symptomatic
ischaemia requiring hospitalisation over a 16-week treatment period among patients
with unstable angina or non-Q-wave acute MI(REF 5) (Fig 2). ASAP provides the
first atherosclerosis regression data for Lipitor(REF 6). The ASAP study showed that
aggressive lipid-lowering therapy with Lipitor (80mg) induced regression of carotid
IMT in patients with high baseline levels of LDL cholesterol whereas moderate lipidlowering therapy with simvastatin did not induce regression (Fig 2). It confirms
previous findings that LDL-C reductions >45% should halt progression completely.
Figure 1: Bertoloni results- Lipitor V’s Pravastatin
Bertoloni et al
10
mean % cahnge in lipid level from baseline
0
TC
LDL-C
HDL-C
Triglycerides
-10
Lipitor 10mg for 16 weeks n=222
pravastatin 20mg for 16 weeks n=77
-20
-30
-40
Figure 2: Summary of MIRACL endpoints
Summary of End Point Events
20
p=0.048, RRR=
16%
18
16
14
% events
12
p=0.02, RRR=
26%
10
Placebo
Atorvastatin
8
6
4
p=0.045, RRR=
50%
2
0
Primary End Point
Myocardial Ischaemia
Fatal or nonfatal Stroke
Figure 3: ASAP study results
Mean Change in Carotid IMT
0.05
0.04
0.03
0.02
0.01
0
Change
(mm)
-0.01
-0.02
-0.03
-0.04
-0.05
1 Year
Atorvastatin
2 Years
Simvastatin
Mean change in all segments combined, intent-to-treat population (N=325).
* P=0.0016 vs baseline, P=0.0001 vs simvastatin; **P=0.0001 vs baseline
Table 1: Lipitor 10mg can potentially treat more patients for less cost than pravastatin
40mg.
Lipitor
pravastatin
Dose required to achieve
a 30% drop in LDL-C
10mg
40mg
Monthly savings from
treating patients
with
Lipitor 10mg
Monthly cost to treat 500
patients
£9,910
£21,380
£11,470
Cardura XL is a new controlled-release formulation that provides smooth, sustained
therapeutic drug levels. It offers prescibling simplicity, a one 4mg starting dose which
avoids the need for titration through 1mg and 2mg doses. Cardura XL aids
compliance because of its fewer first-dose effects than the standard Cardura and has a
lower discotinuation rate than the standard Cardura. Cardura XL offers smooth
systolic and diastolic BP profiles with less first-dose hypotension(REF 7). Cardura
XL helps to treat to target. Studies have shown that a 4mg dose of Cardura XL
controlled the majority of patients without titration(REF 8). Cardura XL offers a cost
benefit when compared to standard Cardura. Cardura XL is an excellent
antihypertensive choice for patients with coexisting conditions such as diabetes,
hyperlipidaemia and renal problems(REF 9-11). It can improve BP control when used
as add-on therapy to help achieve blood pressure targets(REF 12), since a number of
antihypertensives are usually required for tight BP control (REF 13) Table 2. Cardura
XL has no clinically relevant contraindications or adverse drug interactions(REF 14).
It can be combined with four major classes of antihypertensives for added control and
without drug interactions. Table 2 illustrates the current BHS guidelines which
endorses aggressive BP control.
Table 2: BHS BP guidelines
BP TARGET (mmHg)
<140/85
HYPERTENSIVE
No risk factors
<140/85
HYPERTENSIVE
CHD risk factors present
<140/80
DIABETIC
HYPERTENSIVE
<140/85
ELDERLY
HYPERTENSIVE
<130/85*
RENAL
HYPERTENSIVE
* <125/75mmHg if chronic renal disease and proteinuria  1g/24hr
Figure 4:
Number of antihypertensives reuired to achieve tight control in
UKPDS
1 drug
2 drugs
3 drugs or >
REFERENCES:
1. Hunninghake et al, J Family Prac 1998; 47 (5): 349-356
2. Haw et al, IJCP 1999; 53 (6): 422-426
3. Jones et al, Am J Cardiol 1998; 82 (5): 583-587
4. Bertolini et al, Atherosclerosis 1997; 130: 191-197
5. Schwartz et al, JAMA 2001; 285 (13): 1711-1717
6. Smilde et al, Lancet 2001; 357 577-581
7. Gotzen et al, Perfusion 1998; 11: 485-492
8. Os et al, J Cardiovasc Pharmacol 1999; 33: 791-797
9. Huupponen et al, Eur J Clin Pharmacol 1992; 43: 365-368
10. Giordano et al, Diabetes 1995; 44: 665-671
11. Bailey et al, NZ Med J 1986; 99: 942-945
12. Brown et al, J Hypertens 1995; 13: 701-707
13. UK Prospective Diabetes Study Group. Br Med J 1998; 317: 703-713
14. CARDURA Summary of Product Characteristics, March 1999.