New role for cholesterol-lowering drugs

From New Orleans, at a meeting of the American Heart Association

Early, aggressive use of cholesterol-lowering drugs in people who have had a mild heart attack or severe chest pain reduces the risk of heart problems in the near term, according to a new study.

Physicians have widely used a class of drugs called statins to lower cholesterol in patients at risk for heart disease. However, researchers hadn’t studied the drugs in people who have just experienced a heart attack or a bout of chest pains called angina—people who are likely to suffer additional heart problems in the next 3 to 6 months.

An international research group gave 3,086 people either a placebo or a high dose of the cholesterol-lowering drug atorvastatin within 4 days of hospitalization for angina or a heart attack. After 16 weeks, 17.8 percent of those receiving the placebo had either died or survived a bout of serious chest pain or a heart attack. But of those receiving the atorvastatin, only 14.8 percent experienced such fates, reports Gregory Schwartz of the Denver Veterans Affairs Medical Center.

That reduction in risk may seem small, but it’s significant because each year 1 million to 2 million people in the United States suffer angina or heart attack, says Schwartz.

It’s difficult to accurately measure a person’s blood-cholesterol concentration right after a heart attack, which is why doctors typically wait before prescribing cholesterol-lowering drugs. However, the researchers gave the highest recommended dose of the drug, 80 milligrams per day.

Patients with chest pain or who have survived a heart attack “benefit from immediate, aggressive cholesterol lowering, irrespective of their initial cholesterol levels,” Schwartz says.

“Most people aren’t treated with early, aggressive [use of] statins, and it looks like many people would benefit,” agrees Russell V. Luepker of the University of Minnesota at Minneapolis St. Paul.