The effect of early statin treatment on inflammation and cardiac events in acute coronary syndrome patients with low-density lipoprotein cholesterol

Abstract

We investigated the effects of atorvastatin on inflammation and cardiac events during the inpatient period and initial 6-month follow-up in acute coronary syndrome (ACS) patients with low low-density lipoprotein (LDL) cholesterol level. One hundred and twelve consecutive ACS patients with LDL cholesterol less than 100 mg/dl were included in the study (mean 78.2+/-12.3 mg/dl). While 70 randomly selected patients received a dose of 40 mg atorvastatin within the first 24 h on top of their standard treatment as the atorvastatin group, the remaining 42 patients considered as the control group were given the standard treatment only, i.e., without any lipid-lowering drug therapy. Lipid profile, high-sensitivity C-reactive protein (hsCRP), and plasma amyloid A (SAA) levels were measured in all patients within the first 24 h of chest pain, on the 5th day, and in the 6th month. During the inpatient period and subsequent 6-month follow-up, all episodes of angina, reinfarction, revascularization, heart failure, rehospitalization, cardiac mortality, and total number of cardiac events were recorded. In the atorvastatin group, hsCRP and SAA values on the 5th day and in the 6th month compared to the first 24 h were significantly lower than those of the control group (P<0.0001). Mean LDL cholesterol level was significantly decreased in the atorvastatin group (55.7+/-17.7 mg/dl), but there was no significant change in the control group at the 6th month. The frequency of heart failure during the inpatient period and angina, unstable angina pectoris, heart failure, and revascularization in the first 6 months were also significantly reduced in the atorvastatin group. Atorvastatin started in the first 24 h reduces inflammation and improves the prognosis during both the inpatient period and the first 6 months of clinical follow-up in ACS patients with low LDL cholesterol levels.

Prognostic factors in patients who have survived myocardial infarction

“…The importance of hypolipemics, especially statins, in the secondary prevention of MI has been suggested in both recent and earlier studies [22][23][24][25]. In all these studies, as in this study, the use of hypolipemics in patients after the MI as a secondary prevention measure reduced the percentage of adverse coronary events.…”

Impact of Previous Stroke on Short-Term Myocardial Reinfarction in Patients With Acute ST Segment Elevation Myocardial Infarction

“… 10 But for ACS patients with low LDL-C level, statin therapy can benefit similarly. Kanadasi et al 11 found for ACS patients with a low LDL level, atorvastatin can lower the hsCRP and plasma amyloid A values on the 5th day and in the 6th month. Accordingly, Tsai et al 12 included statin therapy can significantly lower the incidence of death, reinfarction, or stroke at 6 months.…”

Part 9: Acute Coronary Syndromes

“…Nineteen studies documented a reduction in short-and long-term major adverse cardiovascular events after intensive treatment with statins within the first 24 hours after hospital admission for patients with ACS (LOE 1 [617][618][619][620][621][622] ; LOE 2 [623][624][625][626][627][628][629][630][631][632][633][634][635] ). Multiple studies reported consistently reduced short-term mortality and reduced incidence of death and nonfatal myocardial infarction during the 30-day follow-up with continued statin treatment or early initiation of this treatment, compared with discontinuation of statins at hospital admission of ACS patients (LOE 3 636 ; LOE 4 [637][638][639][640][641][642][643][644][645] ).…”