New River Medical Center

Statin Therapy During Heart Attack Has Long-term Benefits, Too

Early, aggressive treatment with cholesterol-lowering statin medications gives significant long-term benefits for people who suffer heart attacks or other acute coronary events, says a report in the Archives of Internal Medicine.

According to the National Heart, Lung, and Blood Institute (NHLBI), the major effect of the statins is to lower LDL cholesterol levels, and they lower LDL cholesterol more than other types of medications. LDL cholesterol is the "bad" cholesterol.

Statins inhibit an enzyme which controls the rate of cholesterol production in the body.

These medications lower cholesterol by slowing down the production of cholesterol and by increasing the liver's ability to remove the LDL cholesterol already in the blood.

As a result of their track record in many studies and their ability to lower LDL cholesterol, statins have become the medications most often prescribed when a person needs a cholesterol-lowering medicine, according to the NHLBI.

There are currently five statin medications on the market in the US: lovastatin, simvastatin, pravastatin, fluvastatin, and atorvastatin.

Treatment Has Multiple Benefits

Study author Dr. Jeffrey Jackson, of Walter Reed Army Medical Center, says, "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."

According to the American Heart Association, "acute coronary syndrome" is an umbrella term used to cover any group of clinical symptoms compatible with acute myocardial ischemia. Acute myocardial ischemia is chest pain due to insufficient blood supply to the heart muscle that results from coronary artery disease (also called coronary heart disease).

Dr. 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.

"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 say. The medications also reduce inflammation, lower blood pressure, improve blood-vessel function, and stabilize the build-up of artery-clogging plaque, they note.

A report in the journal Circulation  supports that view, says Dr. Robert A. Stein, director of preventive cardiology at Beth Israel Medical Center 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 persons given statins before bypass surgery.

Statin Therapy Considered Safe

Both Drs. Jackson and Stein say 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," says Dr. Jackson.

"Increasingly, the belief in how much you want to reduce cholesterol has changed over the years," he says. "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."

Dr. Stein says, "In almost every acute coronary syndrome, more is better.”

Fear of possible severe side effects of intensive statin therapy has lessened considerably, notes researchers.

Rates of such side effects as hepatitis were similar in those getting or not getting intensive treatment and "serious adverse effects were rare.

Acute coronary syndrome patients who are not candidates for statin treatment because of allergy or other complicating factors should be treated intensively with other cholesterol-lowering medications, explains Dr. Stein.

Always consult your physician for more information.