Surprising Report on Statins Won't Deter Doctors From Using Them

They see great value in administering the cholesterol drugs to heart patients

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By Ed Edelson
HealthDay Reporter

TUESDAY, May 2, 2006 (HealthDay News) -- Early treatment with cholesterol-lowering statins for people hospitalized with heart attacks or other serious cardiac problems doesn't change patient outcomes over the next four months, a new study reports.

But the cardiologists involved in preparing the study say the discovery won't stop them from giving the drugs to such patients.

"I start statins as soon as the dust settles," said Dr. James A. de Lemos, director of the coronary-care unit at the University of Texas Southwestern Medical Center in Dallas, and an author of the report. "If not on the first hospital day, then on the second. I treat very aggressively."

Dr. R. Scott Wright, a cardiologist at the Mayo Clinic and another author of the report, said, "My patients go on statins as early as possible -- in the emergency room if necessary."

These responses may seem paradoxical in view of the report, which collected data from 12 trials that compared the results for more than 13,000 patients with acute coronary syndrome, a collection of severe problems including heart attacks.

Previous research had shown that long-term treatment with statins reduces the risk of heart attack, stroke and death in patients at varying risks for cardiovascular disease, according to background information in the article. But the short-term benefits of early treatment with statins in patients after the onset of acute coronary syndrome was unclear.

"Based on available evidence, initiation of statin therapy within 14 days following onset of acute coronary syndrome does not reduce death, myocarial infaction [heart attack] or stroke up to four months," the report concluded.

The finding appears in the May 3 issue of the Journal of the American Medical Association.

One reason why Wright said he will go on giving statins to such patients is that the trials reviewed in the new study included a variety of patients given a variety of statins for periods ranging up to two weeks after hospital admission. Very early treatment with potent statin therapy can benefit many patients, he contends.

Patients with acute coronary syndrome already benefit from recent major advances in treatment, Wright said. "It is much safer to halve an acute coronary syndrome today than 10 years ago," he said. "The death rate is half of what it was 10 years ago. Those advances make the relative benefit of statins appear less."

And de Lemos added that the studies included in the new review might not have gone on long enough to show the benefits of early statin treatment. There are benefits, if only because patients started on statins in a hospital are usually more likely to continue to take the medications than those who start them after going home, he said.

Over the long run, "clearly there is a mortality benefit" from early statin therapy, de Lemos said. "It keeps more of my patients alive than would otherwise be the case," he said.

The new report does show some benefits of early statin therapy, most notably a reduction in unstable angina, a potentially life-threatening heartbeat abnormality, de Lemos said.

The bottom line, said Dr. Gregg C. Fonarow, professor of cardiology at the University of California, Los Angeles, is that the new report will not change the current recommendations for medical practice put forth by both the American Heart Association and the American College of Cardiology. Those guidelines call for an early start of statin therapy for acute coronary syndrome.

More information

For more on statins, visit the American Heart Association.

SOURCES: James de Lemos, director, coronary-care unit, University of Texas Southwestern Medical Center, Dalls; R. Scott Wright, cardiologist, Mayo Clinic, Rochester, Minn.; Gregg C. Fonarow, M.D., professor of cardiology, University of California, Los Angeles; May 3, 2006, Journal of the American Medical Association

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