Evidence map›Paper›PMID 15519006›Full record

Trial reportJournal of the American College of Cardiology2004

Clinical outcomes in managed-care patients with coronary heart disease treated aggressively in lipid-lowering disease management clinics: the alliance study.

Michael J Koren, Donald B Hunninghake, ALLIANCE Investigators

2 registry-linked trialsAbstract readClinical TrialComparative StudyMulticenter Study
PubMed Publisher
In one paragraph

Trial report in Journal of the American College of Cardiology, 2004. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 2 registered trials, which are not on this map. Cited by 91 papers, 27 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
91citing papers in PubMed, 27 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT01200056 phase4completedstarted 2007, after this paper: background citation

A Prospective, Double-blinded, Randomised Study to Evaluate the Effects of Different Doses of Statin Treatment on Plaque Volume and Composition in Coronary Disease Determined by Virtual Histology Using Intravascular Ultrasound

Ran2007Enrolled40Registered outcomes2Posted comparisons0ConditionsCoronary Disease, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Ultrasonography, InterventionalArmsAtorvastatin 10mg versus 40mg.
PMID 15249516PMID 15755765PMID 15007110PMID 12114036PMID 12390948PMID 12176951PMID 10687795PMID 11277825PMID 11300468PMID 11368702PMID 11468198PMID 11584167other papers from this trial
Open the trial in the graph
NCT00673036 unknown statusnot on this mapstarted 2005, after this paper: background citation

French Registry of Acute Coronary Syndrome With or Without ST Elevation

TypeobservationalSponsorAssistance Publique - Hôpitaux de ParisRan2005 to 2019Enrolled3,750ConditionsAcute Myocardial InfarctionArmsBlood sample
3 · Its place in the literature

Who cites it

91 citing papers in PubMed, 27 syntheses or guidelines pooled it.

  1. Statins for the primary prevention of venous thromboembolism.The Cochrane database of systematic reviews · 2024
    Pooled it
  2. Benefits and Risks of Antihyperlipidemic Medication in Adults with Different Low-Density Lipoprotein Cholesterol Based on the Number Needed to Treat.American journal of cardiovascular drugs : drugs, devices, and other interventions · 2024 · on this map
    Pooled it
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  5. The association of statin therapy and cancer: a meta-analysis.Lipids in health and disease · 2023 · on this map
    Pooled it
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  9. Prevalence of statin intolerance: a meta-analysis.European heart journal · 2022 · on this map
    Pooled it
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  11. Impact of Lipid-Lowering Therapy on Mortality According to the Baseline Non-HDL Cholesterol Level: A Meta-Analysis.High blood pressure & cardiovascular prevention : the official journal of the Italian Society of Hypertension · 2019
    Pooled it
  12. Guideline
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  19. Guideline
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31 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

3 authors.

Michael J KorenJacksonville Center for Clinical Research, Jacksonville, Florida, USA. michaelkoren@jaxresearch.com
Donald B Hunninghake
ALLIANCE Investigators

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectivesThis study sought to determine if an aggressive, focused low-density lipoprotein cholesterol (LDL-C)-lowering strategy was superior to usual care for coronary heart disease (CHD) patients enrolled in health maintenance organization or Veterans Administration settings.

backgroundStatin therapy benefits are well established. No prospective, randomized studies have tested strategies to optimize these benefits in a "real-world" setting.

methodsA total of 2,442 CHD patients with hyperlipidemia were randomized to either an aggressive treatment arm using atorvastatin or usual care and followed for 51.5 months on average. Atorvastatin-group patients were titrated to LDL-C goals of <80 mg/dl (2.1 mmol/l) or a maximum atorvastatin dose of 80 mg/day. Usual-care patients received any treatment deemed appropriate by their regular physicians. End point assessments were complete in 958 atorvastatin-group and 941 usual-care patients. Partial assessments occurred in 259 patients in the atorvastatin group and 284 patients in the usual care group who did not complete four years of study participation because of adverse events, withdrawn consent, or follow-up loss. The primary efficacy parameter was time to first cardiovascular event.

resultsA total of 289 (23.7%) patients in the atorvastatin group compared with 333 (27.7%) patients in the usual care group experienced a primary outcome (hazard ratio, 0.83; 95% confidence interval 0.71 to 0.97, p = 0.02). This reduction in morbidity was largely due to fewer non-fatal myocardial infarctions (4.3% vs. 7.7%, p = 0.0002). Levels of LDL-C were reduced more (34.3% vs. 23.3%, p < 0.0001) and National Cholesterol Education Program goals (LDL-C <100 mg/dl) more likely met at end-of-study visits (72.4% vs. 40.0%) in patients receiving atorvastatin compared with those receiving usual care.

conclusionsAn aggressive, focused statin therapy management strategy outperformed usual care in health maintenance organization and Veterans Administration clinic patients with CHD.

Indexed as

Ambulatory Care FacilitiesManaged Care ProgramsAdultAgedAtorvastatinBiomarkersCholesterol, HDLCholesterol, LDLCoronary DiseaseDisease ManagementFemaleFollow-Up StudiesHeptanoic AcidsHumansHydroxymethylglutaryl-CoA Reductase InhibitorsHyperlipidemiasAtorvastatinBiomarkersCholesterol, HDLCholesterol, LDLHeptanoic AcidsHydroxymethylglutaryl-CoA Reductase InhibitorsHypolipidemic AgentsPyrrolesTriglycerides

Identifiers

PMID15519006

What Socratic holds

Texttitle and abstract
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.