Monday, March 26, 2007

Early Use of Cholesterol Drug Boosts Outcomes After Angioplasty

(HealthDay News) -- Two new studies confirm and expand the usefulness of anti-cholesterol statin medications, both for relatively healthy patients and those treated for heart attack.

In one trial, patients admitted to a hospital with chest pain fared better a month after angioplasty if they got the statin Lipitor soon after admission to the emergency department.

Another study found that doses of the statin Crestor kept cholesterol plaque at bay in the carotid artery, the prime vessel leading from the heart to the brain.

"These two studies provide further evidence that these drugs are very beneficial against atherosclerosis," otherwise known as "hardening of the arteries," said Dr. Robert Bonow, a spokesman for the American Heart Association and chief of the division of cardiology at Northwestern University Medical School, in Chicago.

He was not involved in either of the trials, the results of which were to be presented Sunday at the American College of Cardiology annual meeting, in New Orleans. The Lipitor study is also being published in the March 27 issue of the Journal of the American College of Cardiology, while the Crestor trial results will appear in the March 28 issue of the Journal of the American Medical Association.

Trial after trial has highlighted the heart-healthy benefits and low side effects of statins, which include blockbusters such as Crestor, Lipitor, Pravachol and Zocor.

The two new studies add to that growing pile of research. In the Lipitor study, researchers in Italy first identified 191 patients at risk of heart attack who arrived at the hospital complaining of "unstable angina" (chest pain). The patients were not already taking any chronic statin medication.

According to Bonow, doctors typically prescribe a statin to patients after a heart attack to lower their risk for a second heart attack or serious complication in the days and weeks that follow. Many of these patients will also undergo an artery-opening procedure, such as angioplasty.

But in this study, half of the patients also received Lipitor in the 12-hour period before their angioplasty.

It seemed to have helped. "Even with this short pretreatment, there is improvement in outcomes," said the study's lead author, Dr. Germano Di Sciascio, director of the department of cardiovascular sciences at the University of Rome.

In fact, just 5 percent of patients who received Lipitor shortly before their angioplasty died, had a nonfatal heart attack, or required another invasive procedure within 30 days of angioplasty, compared to 17 percent of those who only got the statin after the procedure.

"I was not surprised, because we had done other similar studies that have shown a lot of good effects of atorvastatin (Lipitor)," Di Sciascio said. "The most important thing is that even a short treatment works, and it works in the unstable patients going for (angioplasty). Thus, atorvastatin needs to be part of the armamentarium of the interventional cardiologist," he added.

Di Sciascio stressed that his team's study was relatively small and should be confirmed by a larger trial before any major shift in cardiac care occurs. And he said that "it is possible that other statins would have the same effect, however, until now, the benefit has been demonstrated only with atorvastatin, which has been the subject of our study."

Bonow agreed that the findings could help change hospital practice. "Many heart attacks occur out of the blue, and people aren't aware that they have a problem, so many aren't already on these drugs," he said. "So, we tend to start them in the hospital before they go home. But this study suggests that we should do it even earlier, as soon as they hit the door."

In the second study, a team led by Dr. John R. Crouse III, of Wake Forest University in Winston-Salem, N.C., compared the effectiveness of Crestor (rosuvastatin) in nearly 900 patients. The patients were relatively healthy, with only "modest" elevations in LDL ("bad") cholesterol and a mild amount of plaque in their carotid arteries.

Patients got either 40 milligrams of Crestor daily or a placebo, and the researchers tracked carotid plaque levels over two years using high-tech ultrasound.

According to the study, daily Crestor treatment "slowed progression" of artery thickening in this important vessel "at all sites and each segment" tested.

"Carotid artery thickness is a good predictor of who's going to have a heart attack as well as a stroke," Bonow noted. "This (study) is further demonstrating that these drugs are very beneficial, because it is reducing the amount of atherosclerosis in the carotid artery and presumably a lot of other arteries, too."

He said the two studies add to the growing evidence that statin medications are an extremely useful therapy for preventing a wide range of cardiovascular ills.

But they are still not for everyone, Bonow said. "There is about a one percent risk of something bad happening with these drugs," he said. "So, you don't want to give them to everyone, because that one percent would add up to a lot of people."

More information
Find out more about statins at the American Heart Association.

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