Statin lipid-lowering therapy for acute myocardial infarction and unstable angina: Efficacy and mechanism of benefit

R. Scott Wright, Joseph G. Murphy, Kevin A. Bybee, Stephen L. Kopecky, Jean Marc LaBlanche

Research output: Contribution to journalArticle

49 Scopus citations

Abstract

The use of statin agents in patients with acute coronary syndromes (ACSs) remains an area of intense clinical interest. Statin therapy has an established secondary preventive benefit in patients with coronary artery disease, and its extension to ACS seems logical. A number of observational studies have shown an association between initiation of statin therapy early in ACS and improved clinical outcome. Additionally, 4 randomized controlled trials have examined the use of statin therapy for ACS: the Myocardial Ischemia Reduction with Aggressive Cholesterol Lowering (MIRACL) study, the Pravastatin Turkish Trial, the Fluvastatin on Risk Diminishing After Acute Myocardial Infarction (FLORIDA) study, and the Lipid-Coronary Artery Disease (L-CAD) study. Three of these trials showed a benefit with early initiation of statin therapy, whereas 1 trial demonstrated neither benefit nor harm. All the available trials lacked the power and design to sufficiently evaluate whether early initiation of statin therapy reduces mortality and reinfarction in patients with ACS. Four ongoing trials have been designed and sufficiently powered to determine whether statin therapy reduces the risk of death and reinfarction when initiated early in ACS treatment. A body of evidence suggests that the pleiotropic actions of statin agents might modulate benefit in ACS. This article summarizes the available data and provides a rationale for early initiation of statin therapy for patients with ACS.

Original languageEnglish (US)
Pages (from-to)1085-1092
Number of pages8
JournalMayo Clinic proceedings
Volume77
Issue number10
DOIs
StatePublished - Jan 1 2002

Keywords

  • A-to-Z
  • Acs
  • Aggrastat and Zocar trial
  • Ami
  • C-reactive protein
  • Cad
  • Cerivastatin and the Response of IL [Interleukin] 6 and hs-CRP [high sensitivity C-reactive protein] to statin therapy trial
  • Crisp
  • Crp
  • Florida
  • Fluvastatin on Risk Diminishing After Acute Myocardial Infarction
  • L-cad
  • Ldl
  • Lipid-Coronary Artery Disease
  • Miracl
  • Myocardial Ischemia Reduction with Aggressive Cholesterol Lowering
  • Pact
  • Pravastatin Acute Coronary Trial
  • Pravastatin Turkish Trial
  • Pravastatin or Atorvastatin Evaluation and Infection Therapy Trial-Thrombolysis in Myocardial Infarction Grade 22
  • Prevention of Re-Infarction with Cerivastatin Study
  • Princess
  • Prove it-timi 22
  • Ptt
  • Rct
  • acute coronary syndrome
  • acute myocardial infarction
  • coronary artery disease
  • low-density lipoprotein
  • randomized controlled trial

ASJC Scopus subject areas

  • Medicine(all)

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