Early Statin Treatment Research Articles

Going from immutable to mutable atherosclerotic plaques

Atherosclerotic coronary disease develops over several decades and was once thought to be an inevitable, irreversible consequence of aging. Atherogenesis is an inflammatory response that occurs after injury to the endothelium. Thrombosis, because of either endothelial erosion or plaque disruption, precipitates acute coronary events. Effective lipid lowering with statins has consistently and significantly decreased the risk that acute ischemic events will occur. The beneficial effects of statins likely result not only from their lipid-lowering effects but also from mechanisms that influence plaque behavior. Atherosclerotic plaques are not immutable; rather, their structure and composition can be altered by therapeutic modification. Ample evidence from clinical trials supports statin treatment in patients with stable coronary disease. Results of recent clinical trials support early treatment of high-risk patients with unstable coronary disease; early and aggressive statin treatment resulted in fewer recurrent ischemic events in patients with an acute coronary syndrome. Additional studies are needed to confirm the benefit of early statin treatment in patients with unstable coronary disease and to elucidate the reasons for the occurrence of events in treated patients. Research is also necessary to clarify the role of other lipids, as well as nonlipid risk factors, in the occurrence of acute ischemic events.

Ongoing clinical trials of statins

Lipid-lowering treatment with statins is effective for primary and secondary prevention of coronary artery disease in patients with either hypercholesterolemia or average cholesterol levels. Several clinical trials in progress will investigate the use of statins in entirely elderly or diabetic cohorts, and larger trials will continue to include significant numbers of these patients, as well as greater numbers of women. Additional clinical endpoint trials are assessing the potential benefits of lowering lipid levels to below currently recommended goals and of aggressive early statin treatment to prevent ischemic events in patients with stable coronary disease or acute coronary syndromes. These trials are expected to yield important data on the relation of lipid reduction to the prevention of coronary artery disease and on the potential for extending the use of statins.

Early statin treatment following acute myocardial infarction and 1-year survival

The shear stress and hypoxia in the pulmonary artery in patients with pulmonary arterial hypertension(PAH) causes endothelial dysfunction, smooth muscle proliferation and activation of thrombotic pathways leading to in situ thrombosis. Targeting the thrombotic pathways is a proposed mechanism to slow disease progression and improve survival. Over the years, the survival in patients with PAH has improved due to multiple factors with the increased use of anticoagulation as one of them. Both European Respiratory Society/European Society of Cardiology and American College of Cardiology/American Heart Association guidelines make grade II recommendations for using anticoagulation in PAH. The guidelines are based on weak observational studies with high risk of bias which have only studied warfarin as the choice of anticoagulation. In this article, we review the pathophysiology, rationale and the current literature investigating the role of anticoagulation in PAH.

Effect of concomitant or very early statin administration on in-hospital mortality and reinfarction in patients with acute myocardial infarction

In a retrospective analysis, 66 patients identified as having received a statin drug within 24 hours of admission for acute myocardial infarction were matched 3:1 with a control group of 198 patients not treated with a statin agent. End points of in-hospital mortality and in-hospital reinfarction were significantly lower in the statin-treated group, pointing to a benefit from very early statin treatment in acute myocardial infarction.

Early statin treatment

Early statin treatment

Early statin treatment improves long-term survival in patients discharged alive after acute myocardial infarction Ulf Stenestrand, Lars Wallentin, the RIKS-HIA group. Heart Center, University Hospital, Linkoping, Sweden, Dept of Cardiology, University Hospital, Uppsala, Sweden

Early statin treatment improves long-term survival in patients discharged alive after acute myocardial infarction Ulf Stenestrand, Lars Wallentin, the RIKS-HIA group. Heart Center, University Hospital, Linkoping, Sweden, Dept of Cardiology, University Hospital, Uppsala, Sweden

Early statin treatment following acute myocardial infarction and 1-year survival.

Randomized trials have established statin treatment as secondary prevention in coronary artery disease, but it is unclear whether early treatment with statins following acute myocardial infarction (AMI) influences survival. To evaluate the association between statin treatment initiated before or at the time of hospital discharge and 1-year mortality after AMI. Prospective cohort study using data from the Swedish Register of Cardiac Intensive Care on patients admitted to the coronary care units of 58 Swedish hospitals in 1995-1998. One-year mortality data were obtained from the Swedish National Cause of Death Register. Patients with first registry-recorded AMI who were younger than 80 years and who were discharged alive from the hospital, including 5528 who received statins at or before discharge and 14 071 who did not. Relative risk of 1-year mortality according to statin treatment. At 1 year, unadjusted mortality was 9.3% (1307 deaths) in the no-statin group and 4.0% (219 deaths) in the statin treatment group. In regression analysis adjusting for confounding factors and propensity score for statin use, early statin treatment was associated with a reduction in 1-year mortality (relative risk, 0.75; 95% confidence interval, 0.63-0.89; P =.001) in hospital survivors of AMI. This reduction in mortality was similar among all subgroups based on age, sex, baseline characteristics, previous disease manifestations, and medications. Early initiation of statin treatment in patients with AMI is associated with reduced 1-year mortality. These results emphasize the importance of implementing the results of randomized statin trials in unselected AMI patients.

Early Statin Treatment Improves 1-Year Survival After MI

Statins are well established for the secondary prevention of coronary artery disease, but not as treatment for acute coronary syndromes. To determine whether early statin treatment affects long-term survival after MI, these researchers prospectively examined a cohort of 19,599 Swedish patients (maximum age, 79) who each were hospitalized with a first registry-recorded MI from 1995 to 1998; 5528 received statins …

UNSTABLE ANGINA – A DEFINITIVE ROLE FOR STATINS IN SECONDARY PREVENTION

SUMMARYUnstable angina is a life‐threatening disease. The overall incidence is estimated to be between 0.1 and 0.2% and, of those admitted to hospital, up to 5% die within the first six weeks. With such a high prevalence and poor prognosis, there is still a clear need for improved secondary preventive treatment. Several landmark statin trials (CARE, LIPID and 4‐S) have now shown the benefits of lowering cholesterol, starting months after an acute coronary event, and several smaller studies (such as L‐CAD, PTT and RECIFE) have demonstrated the clinical benefits of very early statin treatment. Recent research suggests the underlying cause of the disease, atherosclerosis, is a dynamic and potentially reversible process. Statins may tip this balance in favour of resolution by cholesterol lowering and through pleiotropic effects independent of lipid lowering. Pravastatin, when given very early in the clinical course, has already been shown to improve both plaque stability and endothelial function, as well as clinical outcome, suggesting it as the drug of choice in early secondary prevention. (Int J Clin Pract 2000; 54(6): 383‐389)