New Study Suggests Cholesterol Drugs Should Be Started Sooner
Nov. 15, 2000 (New Orleans) -- For people who have mild heart attacks or severe, disabling chest pain caused by heart disease, the powerful, cholesterol-lowering drugs called statins may reduce the risk of heart attack or death if the drugs are started within four days of hospital admission for heart symptoms.
Currently, statins are given to most people who have what is called "acute coronary syndrome," but the therapy isn't started until several weeks or months after the patient is discharged from the hospital. Heart experts have theorized that giving the drugs earlier could potentially save lives. Researchers tested this theory and found that the drug Lipitor cut the risk of death, heart attack, or worsening chest pain by 16%, compared to patients who got a placebo. The study results were released Wednesday at a meeting of the American Heart Association.
Gregory G. Schwartz, MD, PhD, who presented the results of the study, says that Lipitor also reduced chest pain by 26% and cut stroke by 50%, a result the researchers had not anticipated.
The findings are impressive enough for several members of the adult treatment committee of the National Cholesterol Education Program (NCEP) to say that it's likely that guidelines now being revised will be changed to urge doctors to start giving statins to patients upon diagnosing heart-related chest pain or heart attack. Russell Luepker, MD, of the School of Public Health at the University of Minnesota in Minneapolis, tells WebMD that this means prescribing the drugs even though a patient's blood test for cholesterol may be in the normal range.
The trial involved more than 3,000 patients who were hospitalized after experiencing severe chest pain or a small heart attack. Half of the patients were given atorvastatin and advised to modify their diet, while the other half received a placebo and the same diet recommendations. The patients, whose average age was 65, were followed for 16 weeks.
In addition to initiating therapy early, the MIRACL trial used a "high, aggressive dose of [Lipitor] -- 80 mg," Schwartz tells WebMD.
According to Luepker, who was not involved in the study, that is a very high dose. "I'm not sure we need a dose that high," he says. Because atorvastatin is considered the most potent of the statin drugs, it is often given at lower doses, he says.
"I think we will probably find that we don't need a dose that is quite that high," Valentin Fuster, MD, PhD, tells WebMD. Fuster, director of the cardiovascular institute at Mount Sinai Medical Center in New York and former president of the American Heart Association, also is a member of the NCEP guideline committee.
Fuster says he thinks that when statins are given right after an "acute event," they are able to reduce the formation of blood clots, which often cause heart attack. He says that this effect is independent of the drug's ability to lower cholesterol.
Pfizer, maker of Lipitor, funded the study.