Evidence map›Paper›PMID 29735587›Full record

ArticleCirculation2018

High-Dose Versus Low-Dose Pitavastatin in Japanese Patients With Stable Coronary Artery Disease (REAL-CAD): A Randomized Superiority Trial.

Isao Taguchi, Satoshi Iimuro, Hiroshi Iwata, Hiroaki Takashima, Mitsuru Abe, Eisuke Amiya, Takanori Ogawa, Yukio Ozaki, Ichiro Sakuma, Yoshihisa Nakagawa and 31 more

Erratum issued Registry-linked trialOpen access · hybridAbstract readComparative StudyEquivalence TrialMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Article in Circulation, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. It reports registered trial NCT01042730. Cited by 112 papers, 12 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
112citing papers in PubMed, 12 pooled it
27.0field-weighted citation impact, top 1% of its field
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.

NCT01042730 nacompleted

Randomized Evaluation of Aggressive or Moderate Lipid Lowering Therapy With Pitavastatin in Coronary Artery Disease (REAL-CAD)

Ran2010Enrolled13,054Registered outcomes8Posted comparisons0ConditionsCoronary Artery DiseaseArmsPitavastatin 1 mg daily or 4 mg daily
Open the trial in the graph
3 · Its place in the literature

Who cites it

112 citing papers in PubMed, 12 syntheses or guidelines pooled it, 235 citations in OpenAlex.

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52 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

41 authors at 20 institutions in 3 countries.

Isao TaguchiDepartment of Cardiology, Dokkyo Medical University Koshigaya Hospital, Koshigaya, Japan (I.T.).
Satoshi IimuroTeikyo Academic Research Center, Teikyo University, Tokyo, Japan (S.I., T. Kaneko).
Hiroshi IwataDepartment of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan (H.I., K.M., H.D.).
Hiroaki TakashimaDepartment of Cardiology, Aichi Medical University, Nagakute, Japan (H.T.).
Mitsuru AbeDepartment of Cardiology, National Hospital Organization Kyoto Medical Center, Japan (M.A.).
Eisuke AmiyaDepartment of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo, Japan (E.A.).
Takanori OgawaDepartment of Cardiovascular Medicine, Hokuto Social Medical Corp, Hokuto Hospital, Obihiro, Japan (T.O.).
Yukio OzakiDepartment of Cardiology, Fujita Health University School of Medicine, Toyoake, Japan (Y. Ozaki).
Ichiro SakumaCaress Sapporo Hokko Memorial Clinic, Sapporo, Japan (I.S.).
Yoshihisa NakagawaDepartment of Cardiology, Tenri Hospital, Japan (Y.N.).
Kiyoshi HibiDivision of Cardiology, Yokohama City University Medical Center, Japan (K.H., K. Kimura).
Takafumi HiroDivision of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan (T.H., A.H.).
Yoshihiro FukumotoDivision of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine, Japan (Y.F.).
Seiji HokimotoDepartment of Cardiovascular Medicine, Kumamoto University Hospital, Japan (S.H.).
Katsumi MiyauchiDepartment of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan (H.I., K.M., H.D.).
Tsutomu YamazakiClinical Research Support Center, University of Tokyo Hospital, Japan (T.Y.).
Hiroshi ItoDepartment of Cardiovascular Medicine, Okayama University, Graduate School of Medicine, Japan (H.I.).
Yutaka OtsujiSecond Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, Kita-Kyushu, Japan (Y. Otsuji).
Kazuo KimuraDivision of Cardiology, Yokohama City University Medical Center, Japan (K.H., K. Kimura).
Jun TakahashiDepartment of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (J.T., H.S.).
Atsushi HirayamaDivision of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan (T.H., A.H.).
Hiroyoshi YokoiCardiovascular Center, Fukuoka Sanno Hospital, Japan (H.Y.).
Kazuo KitagawaDepartment of Neurology, Tokyo Women's Medical University, Japan (K. Kitagawa).
Takao UrabeDepartment of Neurology, Juntendo University Urayasu Hospital, Japan (T.U.).
Yasushi OkadaClinical Research Institute and Department of Cerebrovascular Medicine and Neurology, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan (Y.O.).
Yasuo TerayamaDivision of Neurology and Gerontology, Department of Internal Medicine, School of Medicine, Iwate Medical University, Morioka, Japan (Y.T.).
Kazunori ToyodaDepartment of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan (K.T.).
Takehiko NagaoDepartment of Neurology, Nippon Medical School Tama-Nagayama Hospital, Tama, Japan (T.N.).
Masayasu MatsumotoJapan Community Healthcare Organization, Hoshigaoka Medical Center, Hirakata, Japan (M. Matsumoto).
Yasuo OhashiDepartment of Integrated Science and Technology for Sustainable Society, Chuo University, Tokyo, Japan (Y. Ohashi).
Tetsuji KanekoTeikyo Academic Research Center, Teikyo University, Tokyo, Japan (S.I., T. Kaneko).
Retsu FujitaDepartment of Clinical Research Medicine, School of Medicine, Teikyo University, Tokyo, Japan (R.F.).
Hiroshi OhtsuNational Center for Global Health and Medicine, Center for Clinical Sciences, Tokyo, Japan (H. Ohtsu).
Hisao OgawaNational Cerebral and Cardiovascular Center, Suita, Japan (H. Ogawa).
Hiroyuki DaidaDepartment of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan (H.I., K.M., H.D.).
Hiroaki ShimokawaDepartment of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (J.T., H.S.).
Yasushi SaitoChiba University, Japan (Y.S.).
Takeshi KimuraDepartment of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Japan (T. Kimura). taketaka@kuhp.kyoto-u.ac.jp inouet@dokkyomed.ac.jp.
Teruo InoueDepartment of Cardiovascular Medicine, Dokkyo Medical University, Mibu, Japan (T.I.). taketaka@kuhp.kyoto-u.ac.jp inouet@dokkyomed.ac.jp.
Masunori MatsuzakiSt. Hill Hospital, Ube, Japan (M. Matsuzaki).
Ryozo NagaiJichi Medical University, Shimotsuke, Japan (R.N.).
Juntendo University · JPNational Cerebral and Cardiovascular Center · JPNihon University · JPTohoku University · JPAichi Medical University · JPChiba University · JPDokkyo Medical University · JPDokkyo Medical University Saitama Medical Center · JPFujita Health University · JPFukuoka Hospital · JPHokko Memorial Hospital · JPHokuto Hospital · JPHoshigaoka Medical Center · JPIwate Medical University · JPJichi Medical University · JPJuntendo University Urayasu Hospital · JPKazan State Medical University · RUKumamoto University Hospital · JPKurume University · JPKyoto Medical Center · JP

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundCurrent guidelines call for high-intensity statin therapy in patients with cardiovascular disease on the basis of several previous "more versus less statins" trials. However, no clear evidence for more versus less statins has been established in an Asian population.

methodsIn this prospective, multicenter, randomized, open-label, blinded end point study, 13 054 Japanese patients with stable coronary artery disease who achieved low-density lipoprotein cholesterol (LDL-C) <120 mg/dL during a run-in period (pitavastatin 1 mg/d) were randomized in a 1-to-1 fashion to high-dose (pitavastatin 4 mg/d; n=6526) or low-dose (pitavastatin 1 mg/d; n=6528) statin therapy. The primary end point was a composite of cardiovascular death, nonfatal myocardial infarction, nonfatal ischemic stroke, or unstable angina requiring emergency hospitalization. The secondary composite end point was a composite of the primary end point and clinically indicated coronary revascularization excluding target-lesion revascularization at sites of prior percutaneous coronary intervention.

resultsThe mean age of the study population was 68 years, and 83% were male. The mean LDL-C level before enrollment was 93 mg/dL with 91% of patients taking statins. The baseline LDL-C level after the run-in period on pitavastatin 1 mg/d was 87.7 and 88.1 mg/dL in the high-dose and low-dose groups, respectively. During the entire course of follow-up, LDL-C in the high-dose group was lower by 14.7 mg/dL than in the low-dose group (

conclusionsHigh-dose (4 mg/d) compared with low-dose (1 mg/d) pitavastatin therapy significantly reduced cardiovascular events in Japanese patients with stable coronary artery disease. CLINICAL

trial registrationURL: https://www.clinicaltrials.gov. Unique identifier: NCT01042730.

Indexed as

AgedBiomarkersCholesterol, LDLCoronary Artery DiseaseC-Reactive ProteinDyslipidemiasFemaleHumansHydroxymethylglutaryl-CoA Reductase InhibitorsInflammation MediatorsJapanMaleMiddle AgedProspective StudiesQuinolinesRisk AssessmentBiomarkersCholesterol, LDLC-Reactive ProteinHydroxymethylglutaryl-CoA Reductase InhibitorsInflammation MediatorspitavastatinQuinolinescholesterol, LDLcoronary artery diseasehydroxymethylglutaryl-CoA reductase inhibitorslong-term adverse effectssecondary preventionstroke

Identifiers

PMID29735587
PMCPMC5959207
OpenAlexW2801100099

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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 OpenQuestion graph.