Background- Lipid-lowering therapy with statin reduces the risk of cardiovascular events in acute coronary syndrome (ACS). Preclinical and clinical evidence also indicates that in addition to its lipid-lowering effects, statin may reduce inflammation improve endothelial function and increase plaque stability.
Methods- We enrolled 220 patients who had been hospitalized for an acute coronary syndrome (unstable angina, non-ST elevation MI) within the preceding 30 days and compared 20 mg of simvastatin daily (group B) with patients not receiving that (group A). The primary end point was a composite of deaths, myocardial infarction, documented unstable angina requiring re-hospitalization, and urgent revascularization (performed at least 30 days after randomization).
Follow-up lasted for one month.
Results- Median LDL cholesterol level achieved during treatment was similar; 90 mg/dl in group B and 87.1 mg/dl in group A (p> 0.05). Chi-square and t-test estimates of the rate of the documented unstable angina requiring hospitalization were 26.4 percent in group Band 31 percent in group A (odds ratio= 4.5; 95% CI= 2.4-6; P= 0.01). Revascularization and early angiography was 20.9 percent in group Band 48.2 percent in group A (odds ratio= 3.5; 95% CI= 1.9-6.3; P< 0.001). Group B had a lower risk of myocardial infarction after admission due to acute coronary syndrome (odds ratio= 4; 95% CI= 1.1-6; P<0.001), reflecting a reduction in mortality (0.9% in group Band 2.7% in group A), but this difference was not significant (P= 0.6), at least partially because' of the relatively small number of mortalities in this study (1.8%).
Conclusion- Early use of simvastatin in ACS appears to decrease risk for cardiovascular events. We believe statin therapy should be initiated early (at the latest before hospital discharge) in all patients who have been hospitalized for acute coronary syndrome.