Pravastatin therapy in hyperlipidemia: effects on thrombus formation and the systemic hemostatic profile

Dangas, George; Badimón, Juan J.; Smith, Donald A.; Unger, Allen H.; Levine, Daniel; Shao, John; Meraj, Perwaiz; Fier, Carl; Fallon, John T.; Ambrose, John A.

doi:10.1016/s0735-1097(99)00018-2

Cited by 176 publications

(93 citation statements)

References 53 publications

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“…The effect of simvastatin on hsCRP was independent of its effect on LDL cholesterol, supporting data from other studies which have shown that treatment with statins decrease the risk of both first and recurrent coronary events in patients with elevated hsCRP, irrespective of LDL cholesterol levels. 4,6,14,33 The protective effect of statin therapy was recently emphasized when Heeschen and colleagues 34 reported that cessation of statin therapy at the time of presentation with an acute coronary syndrome was associated with a 3-fold increase in cardiac risk compared with patients who continued to take their statin. At the same time, cardiac risk was higher in patients who had never taken a statin when compared with those who had.…”

Section: Discussionmentioning

confidence: 99%

Simvastatin Lowers C-Reactive Protein Within 14 Days

et al. 2002

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Background-The early response of C-reactive protein to initiation of a hydroxymethylglutaryl coenzyme A reductase inhibitor (statin) is not known. The purpose of this study was to determine the rate at which highly sensitive C-reactive protein (hsCRP) levels change after initiation of simvastatin and whether this occurs independently of the change in LDL cholesterol. Methods and Results-The study was a crossover, double-blind design including 40 subjects with elevated LDL cholesterol. Subjects were randomly assigned to 1 of 2 groups: simvastatin 40 mg for 14 days, then placebo for 14 days, or placebo first, then simvastatin. Simvastatin decreased LDL cholesterol by 56Ϯ4 mg/dL (PϽ0.0001) at day 7 and by an additional 8Ϯ3 mg/dL (Pϭ0.02) at day 14. Baseline log(hsCRP) levels were similar in the 2 groups. By day 14, log(hsCRP) was significantly lower in patients on simvastatin when compared with placebo (Pϭ0.011). Although there was no significant difference in fibrinogen levels, simvastatin produced a modest increase in log[lipoprotein(a)] (Pϭ0.03) at days 7 and 14. There were no relationships between the decrease in LDL cholesterol and the decrease in hsCRP. Conclusions-Simvastatin lowers hsCRP by 14 days, independent of its effect on LDL cholesterol. This rapid impact of a statin on hsCRP has potential implications in the management of acute coronary syndromes.

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Section: Discussionmentioning

confidence: 99%

Simvastatin Lowers C-Reactive Protein Within 14 Days

et al. 2002

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“…In the 20 trials that stipulated an inclusion limit by maximum age, the median upper limit was 75 years (IQR [70][71][72][73][74][75]. Mean ages per trial ranged from 48 to 67 years, the mean value of these means being 58.5 years.…”

Section: Gender Age Ethnicitymentioning

confidence: 99%

The causes and effects of socio-demographic exclusions from clinical trials

Bartlett¹,

Doyal²,

Ebrahim³

et al. 2005

Health Technol Assess

180

135

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“…5) In addition to the potent effect of lowering lowdensity lipoprotein (LDL), statins improve endothelial function, 6,7) decrease inflammation, 8,9) and reduce thrombus formation. 10,11) Clinical data from recent observational and randomized studies suggest that statins with pleiotropic effects provide clinical benefit in ACS and favor their administration in ACS patients. [12][13][14][15][16][17][18][19] Stenestrand and Wallentin 12) showed that the 1-year mortality was lower in ACS patients discharged taking statins than in those not taking statins.…”

mentioning

confidence: 99%

Effect of Early Versus Late In-Hospital Initiation of Statin Therapy on the Clinical Outcomes of Patients With Acute Coronary Syndrome

Yang

et al. 2007

Int. Heart J.

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SUMMARYStatins provide effective secondary prevention of cardiovascular events after acute coronary syndrome (ACS). Current guidelines recommend that statins be initiated in ACS patients before hospital discharge. In this retrospective study, we investigated the influence of early compared with late in-hospital initiation of statin therapy on the clinical outcomes of ACS patients.Two hundred and ten ACS patients who had no history of statin treatment before hospitalization were enrolled. The patients were divided into early (statin treatment initiated ≤ 2 days after admission) and late (statin treatment initiated > 2 days after admission and before discharge) statin groups. We examined the association between early statin use and clinical outcomes in these patients using Cox proportional hazards models. Four months after discharge, event-free survival was 85% in the early statin group and 79% in the late statin group. In multivariate analyses, Killip IV classification and abnormal renal function were independent predictors of the composite endpoint of cardiovascular death, recurrent myocardial infarction, angina requiring rehospitalization, revascularization, and stroke. Early statin treatment had no significant influence (hazard ratio: 1.11; 95% confidence interval: 0.54 to 2.25; P = 0.78) on the composite endpoint 4 months after discharge. At 12 months after discharge, early statin treatment still had no significant influence on the composite endpoint (hazard ratio: 1.53; 95% confidence interval: 0.83 to 2.81; P = 0.17).We concluded that ensuring all eligible ACS patients begin statin therapy during their hospital stay is more important than emphasizing immediate statin use after admission. (Int Heart J 2007; 48: 677-688)

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Pravastatin therapy in hyperlipidemia: effects on thrombus formation and the systemic hemostatic profile

Abstract: Pravastatin therapy significantly decreased thrombus formation and improved the fibrinolytic profile in patients with and without CAD. These early effects may, in part, explain the benefit rendered in primary and secondary prevention of CAD.

Cited by 176 publications

References 53 publications

Simvastatin Lowers C-Reactive Protein Within 14 Days

Simvastatin Lowers C-Reactive Protein Within 14 Days

The causes and effects of socio-demographic exclusions from clinical trials

Effect of Early Versus Late In-Hospital Initiation of Statin Therapy on the Clinical Outcomes of Patients With Acute Coronary Syndrome

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