AHA: Early Start for Statins Urged


ORLANDO, Nov. 11 -- Doctors here urged their colleagues to prescribe statins to patients with acute coronary syndrome at the earliest possible time -- even before they leave the hospital -- to provide the most benefit in forestalling coronary events.
In an industry-sponsored symposium held in conjunction with the American Heart Association meeting, doctors cited a series of clinical trials that illustrated benefits for early treatment with statins.
Using data from the PROVE IT -- TIMI 22 trial [NEJM, 2004], Christopher Cannon, M.D., of Harvard and Brigham and Women's Hospital, showed that patients achieved benefit from treatment with atorvastatin (Lipitor) almost from the start of the trial that compared atorvastatin to pravastatin (Pravachol).
"Even in the first 30 days of treatment, the curves between the drugs began to separate," Dr. Cannon said. "There is a clinical benefit of early initiation of high-dose statins after acute coronary syndrome."
Among the advantages of early treatment with high-dose statins, he said, is the reduction in C-reactive protein, a marker of cardiac risk.
Perhaps, suggested Giuseppi Patti, M.D., of Campus Bio-Medico University of Rome, treatment with statins should begin when the patient is undergoing percutaneous coronary intervention.
In the ARMYDA (Atorvastatin for the Reduction of Myocardial Damage During Angioplasty) trial, patients who were given statins within a week after being randomized and before undergoing angioplasty had a 5% rate of myocardial infarction compared with 18% among patients who were on placebo (P=0.0025).
Providing statins to patients who suffer heart attacks should begin within 24 hours of hospitalization, according to AHA/ACC guidelines, said Sidney Smith, M.D., of the University of North Carolina at Chapel Hill.
He said the chance is that 77% of patients started on statins in the hospital will still be on medication 6 months later compared with 25% of patients who are prescribed statins after discharge.
Valentin Fuster, M.D., of Mount Sinai Medical Center in New York, proposed that new advances in imaging technology may help guide decisions on treatment.
"A critical issue for the clinician and for society," said Dr. Fuster, "is the following: Can imaging technology detect subclinical cardiovascular disease and, as a result, foster earlier management to promote health at lower cost?"