The Pharmaceutical Journal
Vol 268 No 7189 p349-354
16 March 2002

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Journal of the American Heart Association (circ.ahajournals.org)

Don't stop statins after MI

Stopping statins after acute myocardial infarction (AMI) nearly triples the incidence of death or subsequent coronary events, report researchers.

Dr Christopher Heeschen, University Hospital Frankfurt, Germany, and colleagues say that early withdrawal of statin therapy after onset of AMI symptoms annuls the protective effect of statins.

The researchers examined the medical records of 1,616 patients who took part in a trial to compare the effectiveness of two anticoagulants. Of these patients, 379 were treated with statins before onset of AMI and 1,151 patients were not. The researchers monitored all patients for 30 days post-MI and found that, if statin therapy was withdrawn during or after admission to hospital, the incidence of death and non-fatal MI was 2.93 times higher than that for patients who continued to receive statins (95 per cent confidence interval, 1.64–6.27, P=0.005). If statin therapy was initiated after onset of the acute coronary syndrome, a trend to a reduced incidence of death and non-fatal MI was observed compared with patients who did not receive statins at all, they say. However, this effect on outcome was less pronounced than that seen for patients pretreated with statins.

The researchers comment that statins increase the release of endothelial nitric oxide (NO) independently of their effect on cholesterol levels. Animal studies have shown that the short-term withdrawal of statins leads to a rebound phenomenon with impaired NO bioavailability. "The discontinuation of statin therapy in our patients with acute coronary syndromes might have ... reversed the upregulation of endothelial NO synthase," the researchers suggest. "These findings are consistent with the hypothesis that statins have significant effects on vascular function independent of their lipid-lowering effects," they add.

The study is published as a rapid access article on the Circulation website (www.circulationaha.org).