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Yet Another Benefit Seen in Cholesterol Drugs


Yet Another Benefit Seen in Cholesterol Drugs
Statins improve heart attack survival rate

By Edward Edelson
HealthScout Reporter

TUESDAY, Jan. 23 (HealthScout) -- Giving heart attack patients with high cholesterol levels one of the cholesterol-lowering drugs called statins reduces the one-year death rate by at least 25 percent, Swedish cardiologists report.

"This is good new for patients with heart disease. It is part of a growing body of evidence that if we initiate treatment with statins soon after a heart attack, we might get better results," says Dr. Sidney Smith, professor of medicine at the University of North Carolina and chief scientific officer of the American Heart Association.

And while the results were achieved with patients with high levels of LDL cholesterol, the kind that clogs arteries, all heart attack patients might benefit from statin therapy, Smith says.

"First, there are effects of statins that go beyond lowering LDL levels. Second, whatever the LDL level is, it is too high for this particular patient, so lowering it from the present level might be beneficial," he says.

Nevertheless, Smith says, "I have not reached the point where I put everybody who has had a heart attack on statins. I am moving toward wondering whether I should. There are more trials out there in the pipeline that could provide an answer to that question."

Writing in the latest issue of the Journal of the American Medical Association, the Swedish researchers, led by Dr. Ulf Stenestrand of the University Hospital of Linkoping, say that while the recently completed MIRACL (Myocardial Ischemic Reduction with Aggressive Cholesterol Lowering) study showed early treatment of heart attack patients with statins improved survival in the first four months, "the proportion of patients with acute myocardial infarction [heart attacks] varies among hospitals."

So they pooled data on nearly 20,000 heart attack patients seen at 58 Swedish hospitals between 1995 and 1998. Of those, 5,528 started statin treatment in the hospital or when they went home.

Statins not only factor

"At one year, adjusted mortality was 9.3 percent (1,307 deaths) in the no-statin group and 4.0 percent (219) deaths in the statin treatment groups," they report.

When they adjusted for a variety of risk factors, including age, sex, smoking habits, diabetes and high blood pressure, they found an overall reduction of 25 percent. Because "the potential benefits seem substantial, and adverse effects few," statin treatment for all heart attack patients with high cholesterol seems advisable, they say.

Dr. Donald A. Smith, director of lipids and metabolism at the Mount Sinai Medical Center in New York City agrees with that assessment, but says he remains cautious starting statin therapy at the time of a heart attack because of the many complicating factors cited in the Swedish study.

"The problem is that when you look at the people who were put on statins, there were many things that predicted they would do better," Smith says. "It was a younger age group, with less congestive heart disease, a little more physical activity, and so on -- all things that tend to improve the survival rate. The subtlety of the things associated with survival are so enormous that it is an incredible job to try to adjust for them."

The argument for putting heart attack patients on statins quickly is that "it is a very benign intervention" that could produce benefits with few bad side effects, Smith says, and he does now prescribe statins for heart attack patients with high cholesterol levels.

But he, like the other Smith, says the ultimate answer will come from carefully controlled, randomized studies that take all the complicating factors into account.

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