Hit 'em Hard and Fast: Statins Early After Heart Attack Improve Outcomes, Save Lives
April 3, 2001 -- In the era of aspirin, clot-busters, and an array of increasingly sophisticated technologies that have put an impressive dent in the number of people dying from heart attacks, it's hard to imagine how another drug could possibly improve these odds. But it's true: When given to patients with mild heart attacks, the powerful cholesterol-lowering pill Lipitor not only lowered their risk of dying from their disease, but also significantly reduced the risk of future heart attacks and strokes.
In the study, more than 3,000 patients received either high doses of Lipitor -- an 80-mg tablet a day -- or placebo within 4 days of a hospital admission for "acute coronary syndrome," the catch-all diagnosis used to describe patients who are having a mild heart attack or severe chest pain or angina with evidence of heart damage. The patients given Lipitor had a 16% reduced risk for having a serious heart attack, worsening of their chest pain, or death, while the risk for having a future stroke was reduced by 50%.
Lipitor, known medically as atorvastatin, is one of the most powerful drugs of a class of medicines called statins. The drugs have been used in patients who have suffered a heart attack to lower their cholesterol levels, but before this study, most patients didn't start statin therapy until a month or so after leaving the hospital. But not any more, says Gary Francis, MD, who oversees the coronary care unit at the Cleveland Clinic Foundation. "This is a very interesting study, and it confirms our belief here at the clinic that very aggressive immediate use of statins is justified," Francis tells WebMD.
The results from this study were first unveiled last November at the American Heart Association meeting, but now they are published in the April 4 issue of the Journal of the American Medical Association.
Gregory G. Schwartz, MD, PhD, who headed up the trial, tells WebMD that this study really provides the first solid evidence to prove the effectiveness of a treatment that many cardiologists already thought would work -- and many already were giving statins this way.
But the "use of statins with these [types of] patients was unchartered territory," Schwartz says, because earlier statin studies always excluded people who had mild heart attacks.
The other important finding is that even heart attack patients with normal or low cholesterol levels can benefit from treatment with a drug such as Lipitor, says Schwartz, who is chief of cardiology at the Colorado Veterans Affairs Medical Center and professor of medicine at the University of Colorado Health Sciences Center in Denver.
The study researchers enrolled patients without regard to their cholesterol levels. As a result, the average LDL, or "bad" cholesterol, level of the patients was just 124 -- lower than the level of 130, at which current national guidelines recommend beginning the use of statin therapy. Schwartz says that because the trial had no lower cholesterol limit entry criteria, even patients with LDL as low as 100 were started on Lipitor within 24-96 hours after admission.