High-dose statin may not be enough to protect acute coronary patients.(Gynecology)

STOCKHOLM -- Patients with acute coronary syndrome who are treated with a high-dose statin and other standard medications still have a high, 13% rate of cardiac events during follow-up, which suggests a need for more interventions to further lower event rates.

"Patients are not fully protected by a statin, aspirin, clopidogrel, an angiotensin-converting enzyme inhibitor, and a [beta]-blocker. They need other treatments, too," Dr. Kausik K. Ray said at the annual congress of the European Society of Cardiology. In his analysis of more than 2,000 patients who received 80 mg of atorvastatin (Lipitor) daily in a recent major trial, Dr. Ray suggested that more diligent control of diabetes, raising the serum levels of HDL cholesterol, and anti-inflammatory treatment might push down event rates even more.

The data came from the intensive-treatment arm of the Pravastatin or Atorvastatin Evaluation and Infection Therapy-Thrombolysis in Myocardial Infarction 22 (PROVE IT-TIMI 22) trial (N. Engl. J. Med 2004;350:1495-504). That study randomized more than 4,000 patients with acute coronary syndrome to treatment with either an intensive (80 mg atorvastatin daily) or moderate (40 mg pravastatin daily) lipid-lowering regimen. The results showed that patients whose LDL cholesterol levels dropped below 70 mg/dL had better outcomes during 2 years of follow-up, compared with patients who had higher levels of LDL cholesterol.

The new analysis focused entirely on the patients who received 80 ...