Hit 'em Hard and Fast: Statins Early After Heart Attack Improve Outcomes, Save Lives
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.
Although the study clearly demonstrates the benefit of getting statins early after a heart attack, heart specialists still are unsure of how much statin these patients need. "This is a very aggressive [high] dose," says Francis, who is a professor of medicine at Ohio State University School of Medicine. Francis points out that the drug used in the study -- Lipitor -- is the most powerful statin currently available. "Typically, a patient would be started on 10 or 20 mg of [Lipitor]," he says.
And although Francis raises questions about the high dose of Lipitor given to patients in this study, he says, "It is very reassuring that there were no adverse events associated with this dose. It appears to be very well tolerated and safe."
Schwartz points out that after several weeks, it may be possible for heart attack patients to take a lower dose of the statin with similar results, although that has not been studied. "I'm not saying that a patient should be maintained on 80 mg for chronic treatment," he says. "I think that after a few months -- in this case four months -- the patient can be evaluated and a lower dose could be initiated."