Statins Help Heart Patients With Inflamed Vessels
Taken before artery procedures, they reduce deaths, heart attacks
WEDNESDAY, March 26, 2003 (HealthDayNews) -- Cholesterol-lowering drugs called statins, taken before procedures to open clogged arteries, greatly reduce death, heart attacks and recurrent artery blockages among patients with high inflammation levels.
That's the conclusion of a new study by researchers at the Cleveland Clinic.
For a year, the researchers followed 1,552 patients who underwent percutaneous coronary intervention (PCI). In this procedure, patients have a blockage opened with balloon angioplasty, a stent or both.
Those with the most elevated levels of high-sensitivity C-reactive protein (hsCRP) -- an indicator of inflammation of blood vessels -- had the greatest benefit from the statins, the study found.
One-quarter of the patients, or 388, had hsCRP levels considered highly elevated -- 1.11 milligram per deciliter or higher.
Among these patients, those who took statins before surgery had 40 percent lower rates of death, heart attacks and need for additional artery-opening procedures a year later, compared with those who did not take statins.
The findings appear in the April 8 issue of Circulation.
"It's quite remarkable that you take these people, presumed to be high-risk, and this really easy intervention seemed to make such a big difference," says study co-author Dr. Deepak L. Bhatt, director of the Interventional Cardiology Fellowship program at the Cleveland Clinic Foundation. "This is actually something that physicians and patients could put to use right away."
The researchers say the study is the first to show that statin therapy before percutaneous coronary intervention lowered inflammation, death rates, heart attacks and need for further artery-opening procedures. Previous research has suggested statins taken after PCI could reduce deaths and heart attacks.
PCI procedures are done each year on about 1.8 million Americans. The procedures include balloon angioplasty, in which a balloon is threaded into a clogged artery and opened to improve blood flow, and use of a stent, a wire mesh tube inserted to prop open an artery.
Dr. Albert W. Chan, the lead investigator in the study, says statins appear to have an effect independent of their cholesterol-lowering function among those with high inflammation levels. So, the findings suggest that levels of high-sensitivity C-reactive protein (hsCRP) may be important in deciding how to treat heart patients, regardless of cholesterol levels.
"This may actually further change our concept of using cholesterol level as the only target for adjusting the dose or starting someone on statins," Chan says.
Chan, who was at the Cleveland Clinic at the time of the study but now is associate director of the Catheterization Laboratory at the Ochsner Clinic Foundation in New Orleans, says the findings, if confirmed by a larger study, could have far-reaching implications.
"I'm very optimistic that CRP (C-reactive protein) will prove to be important to guiding therapy in the future," he says.
Of the 1,552 Cleveland Clinic patients, about 40 percent took statins before percutaneous coronary intervention. Compared with those not taking statins, the study participants were slightly younger (averaging 64 years of age versus 66), had lower median hsCRP levels, were more likely to be taking ACE inhibitors for high blood pressure, and had a history of coronary bypass surgery, the study says.
Statin therapy prior to percutaneous coronary intervention mainly benefited those with the extremely high inflammation levels; it helped those with low inflammation the least, Chan says.
He says the study's findings did not determine when statin treatment should begin. Other research has shown statins lowered hsCRP levels within two weeks, the study says.
The American Heart Association and the U.S. Centers for Disease Control and Prevention do not recommend routine hsCRP testing, but have suggested it may be useful to evaluate patients considered at moderate risk of elevated inflammation.
Dr. David A. Meyerson is a cardiologist at Johns Hopkins Hospital and a spokesman for the American Heart Association. He says, "The study affirms our continued belief that the statins represent a group of invaluable medications in the treatment of coronary heart disease and provide these benefits through a mechanism of action beyond cholesterol-lowering qualities."