Document Detail


Intensive statin therapy in acute coronary syndromes: clinical benefits and vascular biology.
MedLine Citation:
PMID:  15529022     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE OF REVIEW: The results of a landmark clinical study comparing intensive statin therapy with conventional statin therapy, in patients with acute coronary syndromes (ACS), are reviewed. The mechanisms behind these results are analysed drawing data from vascular and cell biology. RECENT FINDINGS: The Pravastatin or Atorvastatin Evaluation and Infection Therapy-Thrombolysis in Myocardial Infarction (PROVE IT-TIMI 22) study showed that intensive statin therapy with 80 mg of atorvastatin to achieve a low-density lipoprotein cholesterol of 62 mg/dl resulted in a 3.9% absolute and a 16% relative risk reduction in death or major cardiovascular events up to 2 years, compared to 40 mg of pravastatin, in patients with ACS. The results were especially significant as intensive statin therapy resulted in a very early benefit (<30 days) and occurred against a background of percutaneous coronary intervention (69%) for the index admission and high use of medications for secondary prevention. The PROVE IT and the Myocardial Ischaemia Reduction with Aggressive Cholesterol Lowering (MIRACL) C-reactive protein sub-study also showed that atorvastatin (80 mg) resulted in a significant reduction in markers of inflammation, whilst the Reversal of Atherosclerosis with Aggressive Lipid Lowering (REVERSAL) study showed that intensive statin therapy was associated with reduced progression of atherosclerosis compared with conventional doses of statins. SUMMARY: Intensive statin therapy results in a significant early reduction in adverse cardiac events in ACS patients which are sustained over 2 years. The early benefits seen are likely to result from modulation of inflammation, endothelial function and coagulation, i.e. the pleiotropic effects, whereas the greater reduction in low-density lipoprotein cholesterol results in reduced long-term events.
Authors:
Kausik K Ray; Christopher P Cannon
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Review    
Journal Detail:
Title:  Current opinion in lipidology     Volume:  15     ISSN:  0957-9672     ISO Abbreviation:  Curr. Opin. Lipidol.     Publication Date:  2004 Dec 
Date Detail:
Created Date:  2004-11-05     Completed Date:  2005-02-22     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  9010000     Medline TA:  Curr Opin Lipidol     Country:  England    
Other Details:
Languages:  eng     Pagination:  637-43     Citation Subset:  IM    
Affiliation:
TIMI Study Group, Cardiovascular Division, Department of Medicine Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA. kkray@partners.org
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MeSH Terms
Descriptor/Qualifier:
Acute Disease
Animals
Cholesterol / blood
Clinical Trials as Topic
Coronary Artery Disease / prevention & control
Coronary Disease / drug therapy*
Endothelial Cells / chemistry
Heptanoic Acids / pharmacology,  therapeutic use*
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors / pharmacology,  therapeutic use*
Myocardial Infarction / drug therapy
Pravastatin / pharmacology,  therapeutic use*
Pyrroles / pharmacology,  therapeutic use*
Syndrome
T-Lymphocytes / immunology
Chemical
Reg. No./Substance:
0/Heptanoic Acids; 0/Hydroxymethylglutaryl-CoA Reductase Inhibitors; 0/Pyrroles; 110862-48-1/atorvastatin; 57-88-5/Cholesterol; 81093-37-0/Pravastatin

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