Statins Stand Out

From the annual scientific session of the American College of Cardiology in Orlando

Statins are the new aspirin.

Several years ago, aspirin gained the reputation of a wonder drug for its very beneficial cardiovascular-protective effects and cheap cost. It’s time to add statins to this list (unless they’re already there).

Reports at this year’s ACC meeting only helped burnish the already glowing reputation of statins.

I blogged a few days ago about the double scored by rosuvastatin in new results from the JUPITER trial. The dramatic mortality and cardiovascular-event benefit seen in the study with 20 mg/day rosuvastatin (Crestor) treatment was confirmed to be in part a C-reactive protein effect, nailing down the suggestion to use a statin in people with “normal” lipid levels but high CRP.

It was the second observation that many cardiologist found even more intriguing: proof that the same statin regimen also stopped many episodes of pulmonary embolism or deep vein thrombosis with no bleeding risk. While the exact role of statins as antithrombotic drugs still needs clarifying, the finding hinted at a new, unexpected, and apparently very safe way to stop unwanted blood clots from forming.

But there’s more. Results from a pair of Italian studies showed that:

1) Administering a bolus, oral dose of 80 mg atorvastatin (Lipitor) to patients not already on a statin during the day before an elective percutaneous coronary intervention (PCI) cut their myocardial infarction rate while in the hospital by about a third. The finding prompted U.S. cardiologist Dr. Chrisopher Cannon to declare that standard practice should now be to start an intensive statin regimen as soon as patients are hospitalized for acute coronary syndrome or coronary catherization.

2) In a separate study of 350 patients who were already on a statin, adding an 80 mg dose of atorvastatin 12 hours before their PCI procedure and a second, 40 mg dose 2 hours before was safe and halved the rate of in-hospital myocardial infarctions. In the subgroup of patients with non-ST elevation myocardial infarction, this extra statin boost cut in-hospital events by about 80%, reported Prof. Germano Di Sciascio from Policlinic University in Rome.
Prof. Germano Di Sciascio  /photo: Mitchel Zoler

Prof. Germano Di Sciascio /photo: Mitchel Zoler

“We believe a statin load is part of the first-line treatment for patients with acute coronary syndrome,” Prof. Di Sciascio said.  A bolus dose of a statin “should probably be given to myocardial infarction patients the same way as aspirin–at the first medical contact,”  before patients even get to the hospital.

—Mitchel Zoler @mitchelzoler

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Filed under Cardiovascular Medicine, Family Medicine, Hospital and Critical Care Medicine, Internal Medicine, Practice Trends

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