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Immediate Statin Cuts Ischemic Events in Unstable Angina.

NEW ORLEANS -- Starting statin therapy immediately in patients with unstable angina or a non--Q-wave myocardial infarction cut the incidence of subsequent ischemic events in a study of more than 3,000 patients.

The finding will likely lead to revision of guidelines for managing acute coronary syndromes (unstable angina and non--Q-wave myocardial infarction) that were issued in September by the American Heart Association.

"We feel strongly that our findings support the immediate use of atorvastatin," Dr. Gregory G. Schwartz said at a press briefing at the annual scientific sessions of the American Heart Association.

The AHA guidelines called for starting treatment with a lipid-lowering drug after metabolic stability is achieved in a patient with acute coronary syndrome and a serum level of LDL cholesterol above 130 mg/dL. If the patient's LDL level is 100-130 mg/dL, the guidelines called for first using diet to try to bring the level below 100 mg/dL. In either case, the start of statin treatment would be delayed for several weeks following the initial coronary event.

But waiting to start treatment means a missed opportunity. "Patients in the hospital after an acute event are the most amenable to accepting treatment. Once they are discharged, patients often don't get the right treatment," said Dr. Schwartz, chief of cardiology at the Veterans Affairs Medical Center, Denver, and a principal investigator in the new trial.

The results "really open the door to using statins in the early stages of acute coronary syndrome," said Dr. Valentin Fuster, director of the Cardiovascular Institute at Mount Sinai Medical Center, New York.

The study enrolled 3,086 patients within 4 days of hospitalization for an acute coronary syndrome event. Patients were excluded if their total cholesterol level at entry was above 270 mg/dL, but there was no lower limit to their serum lipid values. At baseline, the mean total cholesterol level in these patients was 206 mg/dL; their mean LDL-cholesterol level was 124 mg/dL.

The patients were allowed to receive whatever medications their physicians prescribed; most received aspirin, nitrates, a [beta]-blocker, and heparin. The patients were randomized to immediately receive either 80 mg of atorvastatin daily or a placebo. All patients were also encouraged to follow the step 1 diet of the National Cholesterol Education Program.

After 16 weeks, 17,4% of the placebo patients had died, had a nonfatal myocardial infarction, had been resuscitated from cardiac arrest, or had needed urgent hospitalization for worsening angina with new, objective evidence of myocardial ischemia. Patients taking atorvastatin had a 14.8% incidence of this composite end point, a significant, 16% relative reduction. Urgent hospitalization for worsening angina occurred in 8.4% of the placebo patients and 6.2% of those on the active drug, a 26% relative reduction attributable to atorvastatin.

There were 24 strokes with placebo and 12 with the statin, a 50% relative reduction that was statistically significant.

The study was sponsored by Pfizer Inc., maker of atorvastatin (Lipitor).

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Comment:Immediate Statin Cuts Ischemic Events in Unstable Angina.
Publication:Family Practice News
Geographic Code:1USA
Date:Dec 15, 2000
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