Alternate-day versus daily atorvastatin in coronary artery disease: a randomized study

Objective: We sought to compare the effect of alternate-day versus daily atorvastatin 10 mg, on serum low-density lipoprotein cholesterol (LDL-C) and high-sensitivity C-reactive protein (hs-CRP) in patients with coronary artery disease (CAD) and controlled serum LDL-C by daily atorvastatin. Methods: The study was prospective, randomized, single-blinded, two-armed. Randomization was performed by a computer-generated randomization list. We randomized 60 patients with CAD and controlled serum LDL-C to receive either atorvastatin in the standard-dose of 10 mg daily (Group A=30 patients), or the same medication every other day (Group B=30 patients). Primary efficacy criterion included changes in serum LDL-C and hs-CRP from the initial to the 6-week follow-up values. Results: The mean age was 54.5±7.7 years, (70% males). LDL-C was significantly lower in Group A as compared with group B at 6-week follow-up (88±21 versus 105±26 mg/dl, respectively, p=0.008). Similarly, the mean percent increase of LDL-C from baseline to final assessment was significantly lower in Group A as compared with Group B (1.5±0.2 versus 32.8±6.2%, respectively, p 0.0001). However, the mean percent change of hs-CRP value was statistically similar between the two groups (p=0.108). Patients reported no side effects attributable to the medication. Conclusion: The current pilot study demonstrated that in patients with CAD who have achieved target LDL-C level, maintenance on alternateday atorvastatin 10 mg was inferior to daily atorvastatin in keeping LDL-C below the target level; however, it produced a similar effect on hs-CRP.