Statins have demonstrated efficacy ...

Statins have demonstrated efficacy in primary and secondary prevention of coronary artery disease. Although these benefits have been attributed to lipid-lowering events statins may decrease negative issues by other effects such as modulation of inflammation, inhibition of platelet function and thrombosis, and improvement of endothelial function. Data from the Platelet Receptor Inhibition for Ischemic Syndrome Management (PRISM) trial demonstrated better short-term issues in patients with acute coronary syndrome who were already taking statins than in those who were not. Spencer and associates reviewed data from a large multinational observation investigation that compared outcomes in patients with acute coronary syndrome who used statins or received in-hospital statin treatment with patients who did not use statins.

Patients were inserted into the Global Registry of Acute Coronary adventures (GRACE) study based on an initial diagnosis of acute coronary syndrome and were followed for final diagnosis and consequences Previous statin use was defined as taking statins in succession a long-term basis and within seven days of the acute circumstance precipitating hospitalization. In-hospital treatment with statins was defined as initiating statin therapy during hospitalization, and statin use at discharge was defined as initiating statin therapy after discharge.

Patients who already were taking statins were more likely than the other assign places tos to have hyperlipidemia, hypertension, vascular disease, or diabetes, and were slightly les ill at the time of hospitalization. These patients were a great deal less likely to have a final diagnosis of myocardial infarction and were les likely to die during hospitalization or lay open other selected clinical complications. Patients who had used statins previously and continued taking them in the hospital had better consequences than patients who had not taken statins. Initiation of statin therapy during hospitalization in statin-naive patients deductioned in decreased mortality rates and decreased progression in a continuously ascending gradation of serious cardiac complications compared with patients who not ever received statin therapy.

The authors determine that previous or early use of statin therapy improves in-hospital consequences in patients admitted for acute coronary syndrome Pretreated patients were les likely to not past nor future with ST-segment elevation or have a large infarct. These benefits probably are related to tenors other than lipid-lowering. This positive event was less apparent if statin treatment was not continued in the hospital. Statin withdrawal may come in a rebound effect that causes plaque destabilization and increased endothelial dysfunction.

In an editorial in the same journal, Laupacis and Mamdani note that observational studies remain useful for real-life pattern analyses, if it be not that these studies are problematic because of survivor treatment selection bias and competing medical issues. Although statins have been documented in other studies to be useful in patients at high risk of acute coronary syndrome the usefulness of early initiation of statin therapy during hospitalization remains les certain.

Spencer FA, et al. Association of statin therapy with issues of acute coronary syndromes: the GRACE reflection Ann Intern Med June 1 2004;140:857-66 and Laupacis A, Mamdani M Observational studies of treatment effectiveness: near cautions [Editorial]. Ann Intern M June 1 2004;140:923-4

EDITOR'S NOTE: The mostly recent guidelines offered by the National Cholesterol Educa-tion Program throw back additional knowledge from recent clinical trials with statin therapy and clinical last points. Several changes in cholesterol management have been approveed including (1) persons at self-same high risk should have a low-density lipoprotein (LDL) cholesterol goal of < 70 mg by means of dL (1.80 mmol per L) This can be achieved with medication, if necessary; (2) for high- risk patients with grave high-density lipoprotein (HDL) cholesterol or high triglyceride plains a fibrate or nicotinic acid can be added to the lipid-lowering regimen; (3) for moderately high-risk patients (i.e., those with couple or more risk factors), an LDL cholesterol goal of < 100 mg by means of L (2.60 mmol per L) is recom-mended; (4) lifestyle intervention is appropriate for all patients in the to a high degree high-risk or moderately high-risk groups; (5) lipid-lowering therapy should be sufficient to achieve a 30 to 40 percent reduction in LDL cholesterol levels; and (6) the goals of therapy remain unchanged from previous recommendations for patients in lower-risk categories.1 Issues about self-same low LDL cholesterol levels continue to be investigated, and physicians can treat patients as mentioned above or base therapy in succession patient risk and medication efficacy, safety, and costliness (1)--R.S.

REFERENCE

(1) Grundy SM Cleeman JI, Merz NB Brewer HB Jr Clark LT Hunninghake DB et al. Implications of late clinical trials for the National Cholesterol Education Program Adult Treatment Panel III guidelines. Circulation 2004;110:227-39

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