| High-dose atorvastatin enhances the decline in inflammatory markers in patients with acute coronary syndromes in the MIRACL study. | |
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MedLine Citation:
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PMID: 12975259 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Inflammation promotes acute coronary syndromes and ensuing clinical complications. Although statins reduce inflammatory markers in asymptomatic adults or in patients with stable angina, the effect of statins on the markedly heightened inflammation in patients with acute coronary syndromes is unknown. METHODS AND RESULTS: We measured C-reactive protein (CRP), serum amyloid A (SAA), and interleukin 6 (IL-6) in 2402 subjects enrolled the Myocardial Ischemia Reduction with Aggressive Cholesterol Lowering (MIRACL) study. Subjects with unstable angina or non-Q-wave myocardial infarction were randomized to atorvastatin 80 mg/d or placebo within 24 to 96 hours of hospital admission and treated for 16 weeks. The effect of treatment on inflammatory markers was assessed by ANCOVA after adjustment for presenting syndrome, country, and initial level of marker. All 3 markers were markedly elevated at randomization and declined over the 16 weeks in both treatment groups. Compared with placebo, atorvastatin significantly reduced CRP, -83% (95% CI, -84%, -81%) versus -74% (95% CI, -75%, -71%) (P<0.0001) and SAA, -80% (95% CI, -82%, -78%) versus -77% (-79%, -75%) (P=0.0006) but not IL-6, -55% (95% CI, -57%, -53%) versus -53% (95% CI, -55%, -51%) (P=0.3). Reductions in CRP and SAA were observed in patients with unstable angina and non-Q-wave myocardial infarction, with initial LDL cholesterol <3.2 or > or =3.2 mmol/L (125 mg/dL), age > or =65 or <65 years, and in men and women. By 16 weeks, CRP was 34% lower with atorvastatin than with placebo. CONCLUSIONS: High-dose atorvastatin potentiated the decline in inflammation in patients with acute coronary syndromes. This supports the value of early statin therapy in these patients. |
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Authors:
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Scott Kinlay; Gregory G Schwartz; Anders G Olsson; Nader Rifai; Sally J Leslie; William J Sasiela; Michael Szarek; Peter Libby; Peter Ganz; |
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Publication Detail:
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Type: Clinical Trial; Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't Date: 2003-09-15 |
Journal Detail:
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Title: Circulation Volume: 108 ISSN: 1524-4539 ISO Abbreviation: Circulation Publication Date: 2003 Sep |
Date Detail:
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Created Date: 2003-09-30 Completed Date: 2003-10-10 Revised Date: 2006-11-15 |
Medline Journal Info:
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Nlm Unique ID: 0147763 Medline TA: Circulation Country: United States |
Other Details:
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Languages: eng Pagination: 1560-6 Citation Subset: AIM; IM |
Affiliation:
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Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St, Boston, Mass 02115, USA. skinlay@partners.org |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Acute Disease Aged Angina, Unstable / blood, drug therapy*, immunology Apolipoproteins / blood Biological Markers / blood C-Reactive Protein / analysis Cholesterol, LDL / blood Double-Blind Method Female Heptanoic Acids / administration & dosage, therapeutic use* Humans Hydroxymethylglutaryl-CoA Reductase Inhibitors / administration & dosage, therapeutic use* Inflammation / blood, drug therapy Interleukin-6 / blood Male Middle Aged Myocardial Infarction / blood, drug therapy*, immunology Pyrroles / administration & dosage, therapeutic use* Serum Amyloid A Protein Syndrome Troponin / blood |
| Chemical | |
Reg. No./Substance:
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0/Apolipoproteins; 0/Biological Markers; 0/Cholesterol, LDL; 0/Heptanoic Acids; 0/Hydroxymethylglutaryl-CoA Reductase Inhibitors; 0/Interleukin-6; 0/Pyrroles; 0/Serum Amyloid A Protein; 0/Troponin; 110862-48-1/atorvastatin; 9007-41-4/C-Reactive Protein |
| Comments/Corrections | |
Comment In:
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Circulation. 2004 May 11;109(18):e213-4; author reply e213-4
[PMID:
15136515
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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