Early Statin Therapy for Acute Coronary Syndromes

2002 ◽  
Vol 36 (11) ◽  
pp. 1749-1758 ◽  
Author(s):  
Simon de Denus ◽  
Sarah A Spinler
Keyword(s):  
Statin Therapy ◽  
Clinical Benefit ◽  
Acute Coronary Syndromes ◽  
Cardiovascular Events ◽  
Lipid Lowering ◽  
High Dose ◽  
Double Blind ◽  
Early Management ◽  
Medline Search ◽  
Coronary Syndromes

OBJECTIVE: To review the clinical benefit of statins in the early management of acute coronary syndromes (ACSs) and their possible mechanisms of benefit. DATA SOURCES: A MEDLINE search (1966–September 2001) was conducted using the following terms: pravastatin, lovastatin, simvastatin, atorvastatin, cerivastatin, fluvastatin, statins, hydroxymethylglutaryl coenzyme A reductase inhibitor, acute coronary syndromes, unstable angina, and myocardial infarction. Pertinent articles referenced in these publications were also reviewed. STUDY SELECTION AND DATA EXTRACTION: French- and English-language human and animal studies were selected and analyzed. DATA SYNTHESIS: In addition to their lipid-lowering properties, statins produce several nonlipid-related properties. These pleiotropic properties include improved endothelial function, reduction of inflammation at the site of the atherosclerotic plaque, inhibition of platelet aggregation, and anticoagulant effects, all of which may result in clinical benefit during ACSs. Preliminary studies and retrospective analyses of large clinical trials support the hypothesis that statins may be of benefit in ACSs. A recently published randomized, double-blind, multicenter trial evaluated the clinical impact of high-dose atorvastatin in patients with ACSs. Use of atorvastatin resulted in a decrease in a combined endpoint of cardiovascular events. Furthermore, initiation of statin therapy during hospitalization improves long-term compliance and may significantly improve clinical outcome. CONCLUSIONS: Early use of statins in ACSs appears to decrease cardiovascular events. We believe statin therapy should be initiated early (at the latest before hospital discharge) in all patients who have been hospitalized for ACSs. Ongoing studies will clarify the benefit of these agents in ACSs, the importance of their nonlipid-lowering properties, and the optimal cholesterol-target concentrations.

scholarly journals Cardiovascular outcomes trials with statins in diabetes

2018 ◽  
Vol 18 (1) ◽  
pp. 7-13 ◽  
Author(s):  
Fariha Naeem ◽  
Gerard McKay ◽  
Miles Fisher
Keyword(s):  
Cardiovascular Disease ◽  
Side Effects ◽  
Primary Prevention ◽  
Secondary Prevention ◽  
Statin Therapy ◽  
Cardiovascular Events ◽  
Atherosclerotic Disease ◽  
Lipid Lowering ◽  
High Dose ◽  
Drug Side Effects

Treatment with statins is one of the most effective ways of reducing cardiovascular events in those with diabetes. Many studies containing thousands of subjects with diabetes have demonstrated that statins reduce cardiovascular events when there is no known cardiovascular disease (primary prevention) and in those with confirmed atherosclerotic disease (secondary prevention). High-dose statins appear to be even more effective in established cardiovascular disease, but at the expense of increased drug side effects. In this paper we review the evidence for the benefits of statins in diabetes. In a second review we will examine the evidence for possible benefits of other lipid-lowering therapies when these are added to background statin therapy in diabetes.

Cochrane corner: early statin therapy in acute coronary syndromes—what is the clinical benefit?

Heart ◽  
2016 ◽  
Vol 102 (9) ◽  
pp. 653-654 ◽  
Author(s):  
Alain Nordmann ◽  
Gregory Schwartz ◽  
Noah Vale ◽  
Heiner C Bucher ◽  
Matthias Briel
Keyword(s):  
Statin Therapy ◽  
Clinical Benefit ◽  
Acute Coronary Syndromes ◽  
Coronary Syndromes

scholarly journals Cardiovascular outcomes trials with non-statin lipid-lowering drugs in diabetes

2018 ◽  
Vol 18 (3) ◽  
pp. 101-105
Author(s):  
Fariha Naeem ◽  
Gerard McKay ◽  
Miles Fisher
Keyword(s):  
Statin Therapy ◽  
Cardiovascular Events ◽  
Ldl Cholesterol ◽  
Lipid Lowering ◽  
High Dose ◽  
Large Trial ◽  
Pcsk9 Inhibitors ◽  
Vascular Events ◽  
Lipid Lowering Drugs ◽  
Cardiovascular Morbidity And Mortality

Statin therapy is proven to reduce cardiovascular morbidity and mortality in people with diabetes, and high-dose statins are recommended for people with established atherosclerotic vascular disease. In two dedicated studies in people with diabetes, fibrates did not significantly reduce cardiovascular events and were associated with serious side effects. A similar lack of benefit was seen in two large studies of niacin. Ezetimibe, when added to statins, may further reduce LDL cholesterol and non-fatal vascular events. The PCSK9 inhibitors are a new class of subcutaneous lipid- lowering drugs which cause profound reductions in LDL cholesterol when added to statins. Evolocumab reduced non-fatal cardiovascular events when added to background statin therapy in a larger group of subjects and the benefits were confirmed in a diabetes subgroup. In another large trial alirocumab reduced major adverse cardiovascular events and total mortality. The clinical use of ezetimibe and PCSK9 inhibitors is currently limited by cost.

Abstract 13316: Statin Therapy Prevents the Development of Contrast-induced Nephropathy in Patients Undergoing Percutaneous Coronary Intervention for Acute Coronary Syndromes

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Theodoros Zografos ◽  
Gerasimos Siasos ◽  
Evangelos Oikonomou ◽  
Konstantinos Mourouzis ◽  
Stathis Dimitropoulos ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Statin Therapy ◽  
Acute Coronary Syndromes ◽  
Low Dose ◽  
Meta Analysis ◽  
Coronary Intervention ◽  
High Dose ◽  
Contrast Induced Nephropathy ◽  
Percutaneous Coronary ◽  
Coronary Syndromes

Introduction: Contrast-induced nephropathy (CIN) is often encountered following percutaneous coronary intervention (PCI) in patients with acute coronary syndromes (ACS) and is associated with high in- hospital morbidity and mortality. Statins may prevent the development of CIN, however their efficacy in patients with ACS has not been evaluated. Hypothesis: We conducted a meta-analysis of randomized controlled trials (RCTs) to assess statin efficacy in the prevention of CIN in patients undergoing PCI for ACS. Methods: PubMed, EMBASE, MEDLINE and the Cochrane Central Register were searched for RCTs from inception to September 2014 to compare high-dose statins (rosuvastatin 40mg/day, atorvastatin 80mg/day or simvastatin 80mg/day) with low-dose (atorvastatin 10mg/day, simvastatin 10mg/day) o placebo treatment in patients with ACS, undergoing PCI. Study-specific odds ratios (ORs) were calculated, and between-study heterogeneity was assessed using the I2 statistic. We used a random effects model meta-analysis to pool the OR. Results: Seven RCTs, including 5174 patients were included in the analysis. CIN occurred in 126 (4.9 patients in the high dose statin group and in 232 (8.9%) patients in the low dose or placebo group (OR: 0.50, 95% confidence interval: 0.38- 0.66, p<0.001). The observed heterogeneity between the included studies was low (I2=19%, p=0.28). Conclusions: High-dose statin therapy is effective at preventing the development of CIN in the high-risk population of patients undergoing PCI for ACS.

scholarly journals Statin non-adherence: clinical consequences and proposed solutions

F1000Research ◽  
2016 ◽  
Vol 5 ◽  
pp. 714 ◽  
Author(s):  
Robert S. Rosenson
Keyword(s):  
Coronary Heart Disease ◽  
Clinical Trials ◽  
Adverse Events ◽  
Statin Therapy ◽  
High Intensity ◽  
Acute Coronary Syndromes ◽  
Cardiovascular Events ◽  
Treatment Options ◽  
Stable Coronary Heart Disease ◽  
Coronary Syndromes

Large controlled clinical trials have demonstrated reductions with statin therapy in cardiovascular events in patients presenting with acute coronary syndromes and stable coronary heart disease and individuals at high risk of a cardiovascular event. In trials of acute coronary syndromes and stable coronary heart disease, high-intensity statin therapy is more effective in the prevention of recurrent cardiovascular events than low-intensity statin therapy. Thus, evidence-based guidelines recommend in-hospital initiation of high-intensity statin therapy for all acute coronary syndrome patients. Clinical trials report high adherence to and low discontinuation of high-intensity statin therapy; however, in clinical practice, high-intensity statins are prescribed to far fewer patients, who often discontinue their statin after the first refill. A coordinated effort among the patient, provider, pharmacist, health system, and insurer is necessary to improve utilization and persistence of prescribed medications. The major cause for statin discontinuations reported by patients is perceived adverse events. Evaluation of potential adverse events requires validated tools to distinguish between statin-associated adverse events versus non-specific complaints. Treatment options for statin-intolerant patients include the use of a different statin, often at a lower dose or frequency. In order to lower LDL cholesterol, lower doses of statins may be combined with ezetimibe or bile acid sequestrants. Newer treatment options for patients with statin-associated muscle symptoms may include proprotein convertase subtilisin kexin 9 (PCSK9) inhibitors.

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