Early reduction in serum lipids with atorvastatin initiated immediately after an acute coronary event reduces the risk of early death and non-fatal ischaemic events, according to new research.
In the MIRACL (myocardial ischaemia reduction with aggressive cholesterol lowering) double-blind, placebo-controlled study Professor Gregory Schwartz (University of Colorado health sciences centre, Denver, United States) randomly assigned 3,086 patients at high risk of recurrent ischaemic events to receive either atorvastatin 80mg or placebo once daily for 16 weeks. Participants, from 122 centres in 19 countries, were assigned their regimen within 24 to 96 hours of hospital admission following unstable angina or non-Q wave myocardial infarction.
The primary combined endpoint of the study was the time taken to the first event after hospitalisation and included death (any cause), non-fatal myocardial infarction, resuscitated cardiac arrest and worsening angina with new objective evidence and urgent rehospitalisation. Secondary endpoints included stroke and myocardial revascularisation.
The researchers said that participants treated with atorvastatin experienced a significant reduction (16 per cent) in the risk of primary combined endpoints. This was primarily due to atorvastatin reducing recurrent symptomatic myocardial ischaemia (by 26 per cent). Professor Schwartz said that the incidence of stroke decreased by 50 per cent in the atorvastatin group compared with placebo. LDL-cholesterol levels in participants declined from an average of 3.2mmol/L at baseline to 1.9mmol/L during treatment with atorvastatin.
Speaking in New Orleans, Professor David Waters (chief of cardiology, San Francisco general hospital), who was also involved in the study, said that the long term effects of atorvastatin 80mg had not been studied and therefore the researchers did not know whether decreasing the dose following benefit after four months would continue to have the same effects.
Professor Anders Olsson (University hospital, Linköping, Sweden) told The Journal on November 16 that, further to these findings, the dose of atorvastatin that should be given immediately after a coronary event also depended on patients' lipid levels at that time.