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BRAVER Trial

BR achial A rtery V ascular E ndothelium R eactivity Study A substudy of PROVE IT-TIMI 22. BRAVER Trial. BRAVER: Study design. Substudy of PROVE IT-TIMI 22. Objective: – Evaluate time course of improvement in endothelial function with statin after acute coronary syndromes (ACS)

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BRAVER Trial

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  1. BRachial Artery Vascular Endothelium Reactivity Study A substudy of PROVE IT-TIMI 22 BRAVER Trial

  2. BRAVER: Study design Substudy of PROVE IT-TIMI 22 Objective: – Evaluate time course of improvement in endothelial function with statin after acute coronary syndromes (ACS) – Compare effects of intense vs moderate statin therapies on vascular reactivity Design: Randomized double-blind 2 x 2 factorial design Population: N = 50 with ACS; total cholesterol ≤240 mg/dL* Treatment: Atorvastatin 80 mg (n = 24) or pravastatin 40 mg (n = 26) Outcome: Amount of change in brachial artery reactivity measured by high-resolution ultrasound at days 2, 30, and 120 *≤200 mg/dL if on long-term lipid-lowering drugs BRachial Artery Vascular Endothelium Reactivity Dupuis J et al. Am J Cardiol. 2005;96:1207-13.

  3. BRAVER: Results • 32% reduction in LDL-C with atorvastatin 80 mg (P < 0.001 vs baseline) vs no reduction with pravastatin 40 mg after 4 months • Similar reductions in C-reactive protein (CRP) in both treatment groups • 27% increase in FMD; 24% increase in NMD (P <0.05 vs baseline), with no difference between treatment strategies • Changes in FMD, lipid levels, and CRP were not correlated • FMD and NMD remained unchanged in patients treated with statins prior to ACS (n = 15) FMD = Endothelium-dependent flow-mediated dilation NMD = Endothelium-independent sublingual nitroglycerin-mediated dilation BRachial Artery Vascular Endothelium Reactivity Dupuis J et al. Am J Cardiol. 2005;96:1207-13.

  4. BRAVER: Clinical implications • Statin therapy soon after ACS improves endothelium-dependent and endothelium-independent vascular reactivity • Improvements observed after 4 months of treatment • Results comparable despite differing intensities of treatment • Power to detect differences between atorvastatin and pravastatin groups was limited; findings add to growing evidence that improvement in vascular reactivity with statins is independent of the importance of lowering cholesterol • Lack of improvement in subjects previously using statins suggests new statin initiation is needed for major improvements in vascular reactivity after ACS BRachial Artery Vascular Endothelium Reactivity Dupuis J et al. Am J Cardiol. 2005;96:1207-13.

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