Intensive Statin Therapy Beneficial in Heart Emergencies

Studies find a reduction in deaths, cardiovascular problems

MONDAY, Sept. 25, 2006 (HealthDay News) -- Early, aggressive treatment with cholesterol-lowering statin drugs gives significant long-term benefits for people who suffer heart attacks or other acute coronary events, a new study of studies shows.

"We found that if you gave someone with an acute coronary syndrome statin treatment, it reduced the incidence of heart attacks and other cardiac events over the next two years by more than 18 percent," said Dr. Jeffrey Jackson, program director of the general medicine fellowship program at Walter Reed Army Medical Center, in Washington, D.C.

Jackson and his colleagues analyzed the results of 13 previous studies in which intensive statin therapy was or was not begun for nearly 18,000 patients within 14 days of hospitalization for an acute coronary syndrome. They found major benefits for those getting aggressive statin treatment, compared to patients who received low-dose or no statin treatment.

The findings were published in the Sept. 25 issue ofArchives of Internal Medicine.

"These benefits took more than four months to begin to accrue and were sustained for two years," the researchers wrote. "During those two years, there was slightly less than a 20 percent reduction in the risk of experiencing an adverse cardiac event."

Part of the benefit is due to something other than the cholesterol-lowering effect of statins, the researchers said. The drugs also reduce inflammation, lower blood pressure, improve blood-vessel function and stabilize the build-up of artery-clogging plaque, they noted.

A report being published this week in the journal Circulation supports that view, said Dr. Robert A. Stein, director of preventive cardiology at Beth Israel Medical Center in New York City and a spokesman for the American Heart Association.

In that report, Italian cardiologists described a major reduction in the incidence of atrial fibrillation, a dangerous abnormal heartbeat, in people given statins before bypass surgery.

Both Jackson and Stein said the view that intensive statin therapy is beneficial for acute coronary syndrome has strengthened as more study results become available.

"Most people are in tune with the notion that you want to reduce cholesterol in such cases," Jackson said. "Increasingly, the belief in how much you want to reduce cholesterol has changed over the years. First you wanted to get below 160, then below 130, then below 100, then to 70. Now you want to be aggressive, give high doses early and don't wait."

"In almost every acute coronary syndrome, more is better," Stein said of statin therapy.

Fear of possible severe side effects of intensive statin therapy has lessened considerably, the Walter Reed study said. Rates of such side effects as hepatitis were similar in those getting or not getting intensive treatment and "serious adverse effects were rare," they noted.

Acute coronary syndrome patients who aren't candidates for statin treatment because of allergy or other complicating factors should be treated intensively with other cholesterol-lowering drugs, Stein said.

More information

For more on statins, visit the U.S. National Heart, Lung, and Blood Institute.

SOURCES: Jeffrey Jackson, M.D., director, general medicine fellowship program, Walter Reed Army Medical Center, Washington, D.C.; Robert A. Stein, M.D., director of preventive cardiology, Beth Israel Medical Center, New York City; Sept. 25, 2006, Archives of Internal Medicine; Sept. 26, 2006, Circulation
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