People brought to a hospital in the throes of a heart attack are more likely to survive if they receive a statin drug, a new study finds. The report could pave the way for a trial to ascertain whether doctors should routinely use the cholesterol-lowering agents to stabilize these heart patients.
Guidelines for physicians recommend prescribing statins to hospitalized heart attack sufferers only as they are being discharged. But some doctors now give statins to such patients much sooner, a practice based on animal tests suggesting that the drugs’ effects go beyond fighting cholesterol.
To test whether these doctors are on to something, cardiologist Gregg C. Fonarow of the University of California, Los Angeles and his colleagues analyzed the records of 174,635 heart attack patients admitted to U.S. hospitals between 2000 and 2002. About a fourth of the group had gotten a statin in the first 24 hours after being hospitalized. The statin family includes Lipitor and Crestor.
The researchers report in the Sept. 1 American Journal of Cardiology that about 5 percent of people receiving the early statin treatment died in the hospital. In contrast, roughly 16 percent of people who didn’t receive statins within 24 hours died while hospitalized.
When comparing heart attack patients of similar gender, race, lifestyle, and health-risk factors such as smoking, the researchers found that those not getting statins promptly were more than twice as likely to die in the hospital as were the others.
“This is an intriguing study. The effect is whopping,” says cardiologist George Sopko of the National Heart, Lung, and Blood Institute in Bethesda, Md.
Heart attack patients arriving in a hospital usually get aspirin to discourage blood clots. They also receive beta-blockers to stabilize heartbeat and relax the heart. Some get powerful blood-clot dissolvers.
The statins’ cardiac benefits derive from their ability to activate biochemical processes that rescue heart tissues starved of blood during a heart attack, according to Kenneth Walsh, a molecular biologist at Boston University School of Medicine, who didn’t participate in the new study.
“Statins promote the synthesis of nitric oxide,” Walsh explains, “and that generally tends to be good for the heart.” Nitric oxide subdues inflammation in injured tissues, prevents cell death, and offsets the damaging effects of free radicals, he says.
Sopko cautions that it’s too early to recommend statins as a routine response to heart attacks. But the new study sets the stage for a comparison between heart attack patients getting statins and others receiving placebos, the only true test of a drug therapy, he says. “If we are going to use statins as standard [emergency] therapy, like aspirin, we need more solid evidence,” Sopko says.