Effects of Atorvastatin on Early Recurrent Ischemic Events in Acute Coronary Syndromes&lt;SUBTITLE&gt;The MIRACL Study: A Randomized Controlled Trial&lt;/SUBTITLE&gt;

Schwartz, Gregory G.; Olsson, Anders; Ezekowitz, Michael D.; Gänz, Peter; Oliver, M.F.; Waters, David D.; Zeiher, Andreas M.; Chaitman, Bernard R.; Leslie, Sally J.; Stern, Theresa

doi:10.1001/jama.285.13.1711

Cited by 2,181 publications

(305 citation statements)

References 19 publications

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“…FMDand IMT at baseline and at six monthswere4. 1 Major adverse cardiovasculare vents occurredi n 2.1% in the atorvastatingroup and 1.9% in the control group (p= 0.61). In conclusion, in this pilott riala ggressive lipid-lowering with 80 mg of atorvastatindailyfor six monthshad no effect on brachial artery FMD in patients with PAD.…”

Section: Discussionmentioning

confidence: 96%

High-dose atorvastatin in peripheral arterial disease (PAD): Effect on endothelial function, intima-media-thickness and local progression of PAD

Spring¹,

Simon²,

Loo³

et al. 2008

Thromb Haemost

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Beneficial effects of aggressive lipid-lowering with high-dose atorvastatin (80 mg/day) have been demonstrated in patients with coronary and cerebrovascular disease. The impact of such a therapy in patients with peripheral arterial disease (PAD) is less known so far. Here we studied the effects of high-dose atorvastatin on brachial artery endothelial function, common carotid intima-media thickness (IMT) and local progression of PAD in these patients. One hundred of 500 patients screened with documented PAD were randomly assigned to receive 80 mg of atorvastatin daily for six months or to continue on conventional medical treatment. Ninety-six percent of patients in the control group were on standard statin treatment. High resolution B-mode ultrasonography was used to study brachial artery flow-mediated dilation (FMD), IMT and ankle-brachial index (ABI) at baseline and at six months. FMD and IMT at baseline and at six months were 4.1 (0.06-8.6) versus 5.0 (0.76 vs. 8.1) %, p = 0.96, and 0.76 (0.66-0.82) versus 0.73 (0.63-0.81) mm, p = 0.41, respectively, in the atorvastatin group, and 2.66 (-1.9-6.9) versus 3.65 (0.0-8.6)%, p = 0.02, and 0.78 (0.71-0.90) versus 0.77 (0.70-0.90) mm, p = 0.48, in the control group. ABI at baseline and at six months was not different in either group. LDL cholesterol was reduced from 2.53 (2.21-3.28) to 1.86 (1.38-2.29) mM (p < 0.0001) in the atorvastatin group, whereas levels remained stable in the control group [2.38 (1.94-3.16) vs. 2.33 (1.82-2.84) mM, p = 0.61]. Major adverse cardiovascular events occurred in 2.1% in the atorvastatin group and 1.9% in the control group (p = 0.61). In conclusion, in this pilot trial aggressive lipid-lowering with 80 mg of atorvastatin daily for six months had no effect on brachial artery FMD in patients with PAD. IMT and ABI were also similar in patients with and without high-dose atorvastatin at six months. Major adverse cardiovasculare vents occurredi n 2.1% in the atorvastatingroup and 1.9% in the control group (p= 0.61). In conclusion, in this pilott riala ggressive lipid-lowering with 80 mg of atorvastatindailyfor six monthshad no effect on brachial artery FMD in patients with PAD. IMT andABI were also similar in patientswith and without high-doseatorvastatin at six months.

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Section: Discussionmentioning

confidence: 96%

High-dose atorvastatin in peripheral arterial disease (PAD): Effect on endothelial function, intima-media-thickness and local progression of PAD

Spring¹,

Simon²,

Loo³

et al. 2008

Thromb Haemost

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“…High‐intensity statin therapy has been shown in several randomized trials20, 21, 22, 23 to be superior to moderate‐intensity statin in further reducing major cardiovascular events, and a recent report from observational data has shown a survival benefit of high‐intensity statin over submaximal statin therapy. Adherence to guideline recommendation to use high‐intensity statins rather than moderate‐intensity statin among our cohort could potentially prevent >1800 cardiovascular events over a 10‐year period.…”

Section: Discussionmentioning

confidence: 99%

Temporal Trends of High‐Intensity Statin Therapy Among Veterans Treated With Percutaneous Coronary Intervention

Abdulhak

Vaughan-Sarrzin

Kaboli

et al. 2018

JAHA

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BackgroundThe 2013 American College of Cardiology/American Heart Association blood cholesterol guideline recommends high‐intensity statin therapy among certain groups of patients, but full implementation of the guideline has not yet been satisfactory. We aimed to investigate the temporal trends and predictors of high‐intensity statin therapy among veterans who had been treated with percutaneous coronary intervention (PCI) and followed up by cardiologists within the Veterans Health Administrative system.Methods and ResultsA retrospective cohort study was conducted at the Veterans Health Administrative system including all patients >18 years old who had their PCI procedure between October 2010 and September 2016. National Veterans Health Administrative databases were used to retrieve study participant's demographics, comorbid conditions, statin type and dose within 90 days before and after the PCI procedure. There were 48 862 patients who underwent a PCI procedure during the study period. High‐intensity statin use at 90 days post‐PCI rose from 23% in 2010 to 37% before release of the 2013 American College of Cardiology/American Heart Association cholesterol guideline, then rose sharply to 80% by 2016. The projected 10‐year risk of arteriosclerotic cardiovascular disease events among our study population was projected to be ≈1841 fewer if the cohort had received high‐intensity statin therapy versus moderate‐intensity statin.ConclusionsBy 2016, the 2013 American College of Cardiology/American Heart Association blood cholesterol guideline was well implemented among veterans who had a PCI procedure in the Veterans Health Administrative system, suggesting systems of care can be improved to increase rates of high‐intensity statin initiation.

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“…Several animal studies have shown reduction of IR-injury as a result of statin treatment in both the heart and the kidney [14][15][16][17] . This putative protection may explain the clinical observation that early initiation of statin treatment in patients with an acute cardiovascular event improves long-term prognosis as compared with a delayed start of this treatment [18][19][20] . Furthermore in two randomised clinical trials one day treatment with…”

Section: Introductionmentioning

confidence: 99%

Atorvastatin does not Affect Ischaemia-Induced Phosphatidylserine Exposition in Humans in-vivo

Wouters

Meijer

Janssen

et al. 2012

JAT

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Aim: Statins can induce pharmacologic preconditioning and thereby reduce infarct size. Cellular phosphatidylserine (PS) exposition occurs in the course of ischaemia and reperfusion and has been associated with injury. In this experiment we studied the effect of atorvastatin on PS exposition after a standardised ischaemia and reperfusion challenge. Methods: In a double-blind randomised cross-over trial 30 healthy volunteers were allocated to 3 day treatment with atorvastatin (80 mg/day) and placebo (n = 24), or placebo treatment twice (n = 6). At the end of each treatment period, volunteers underwent 10 minutes of forearm ischaemic exercise. At reperfusion radiolabeled annexin A5 was administered intravenously and Gamma camera imaging of both hands was performed 1 and 4 hours after reperfusion.

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Effects of Atorvastatin on Early Recurrent Ischemic Events in Acute Coronary Syndromes<SUBTITLE>The MIRACL Study: A Randomized Controlled Trial</SUBTITLE>

Abstract: For patients with acute coronary syndrome, lipid-lowering therapy with atorvastatin, 80 mg/d, reduces recurrent ischemic events in the first 16 weeks, mostly recurrent symptomatic ischemia requiring rehospitalization.

Cited by 2,181 publications

References 19 publications

High-dose atorvastatin in peripheral arterial disease (PAD): Effect on endothelial function, intima-media-thickness and local progression of PAD

High-dose atorvastatin in peripheral arterial disease (PAD): Effect on endothelial function, intima-media-thickness and local progression of PAD

Temporal Trends of High‐Intensity Statin Therapy Among Veterans Treated With Percutaneous Coronary Intervention

Atorvastatin does not Affect Ischaemia-Induced Phosphatidylserine Exposition in Humans in-vivo

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