Can early, aggressive statin use cut cardiovascular events?
It remains unclear whether aggressive use of statins to lower cholesterol after an acute coronary syndrome (ACS) event may prevent death and major cardiovascular events, following inconclusive results from a new trial.
The study, the second part of the “A to Z” (Aggrastat to
Zocor) trial, compared an early, aggressive approach to statin treatment
with delayed, lower dose treatment.
In the trial, 2,265 patients who had had an ACS event received aggressive
statin therapy (40mg simvastatin for 30 days followed by 80mg per day),
and 2,232 patients were randomised to less aggressive therapy (placebo
for 30 days followed by 20mg simvastatin per day). Patients were followed
up for six to 24 months.
In the less aggressively treated group, 16.7 per cent of patients experienced
a heart attack, stroke or cardiovascular death or were readmitted to
hospital, compared with 14.4 per cent of those treated early and aggressively
(P=0.14). The results are not statistically significant, but the authors
point out that, in the aggressively treated group, cardiovascular death
occurred in 4.1 per cent of patients and congestive heart failure occurred
in 3.7 per cent, compared with 5.4 per cent and 5 per cent, respectively,
in the less aggressively treated group (P values 0.05 and 0.04). The
aggressively treated group also experienced a 0.4 per cent increase in
myopathies compared with the less aggressively treated group.
An accompanying commentary points out: “It is important to reassure
practising physicians and patients that the unfavourable risk-benefit
relationship observed in the A to Z trial does not in any way diminish
the value of intensive statin treatment in secondary prevention.”
The study was presented at the European Society of Cardiology this week
and is also published in an express article in JAMA (2004;292:1307). |
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