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Statins May Help Before Artery-Opening Surgery
Date:3/30/2009

Italian studies report fewer heart attacks after procedures ,,

MONDAY, March 30 (HealthDay News) -- Giving statins just before artery-opening angioplasty procedures reduces the incidence of heart attacks and other problems, even for people who already have been taking the cholesterol-lowering drugs, Italian trials show.

It's not the effect that statins have on cholesterol that is responsible for the benefits but rather their ability to reduce inflammation and other problems associated with heart disease, said Dr. Carlo Briguori, a cardiologist at the Clinica Mediterranea in Naples, who was to report the findings Monday at the American College of Cardiology annual meeting, in Orlando, Fla.

His study included 688 people who were having the procedure that cardiologists formally call percutaneous coronary intervention (PCI), in which angioplasty is performed and a stent is then placed in the artery. None had been taking statins before PCI was scheduled. About half of them were give 40 milligrams of atorvastatin (Lipitor) in the 24 hours before the procedure, and the others did not take the drug.

Within 12 hours of the procedure, 15.8 percent of those who were not given a statin had a heart attack, compared with 9.5 percent of those given atorvastatin, Briguori reported.

"This supports the concept that a high loading dose of a statin a day before PCI can have a beneficial effect," he said.

But that trial included only people who had not been taking a statin, and "this patient population is disappearing," said Dr. Germano Di Sciascio, chairman of cardiology at the University of Rome, who reported on a second trial at the meeting. "The vast majority of people who come to the catheterization laboratory are on statins," he said. "In our group, it was 70 percent of patients."

His study included 352 people with heart problems such as stable angina -- chest pain caused by narrowed cardiac arteries -- who had been taking statins. Half of them took 80 milligrams of atorvastatin 12 hours before PCI, with an additional 40 milligrams just before the procedure. The other half took a placebo.

The incidence of major cardiac problems, such as heart attacks, was 48 percent lower in those who took the statin before their procedure, Di Sciascio reported. Blood levels of C-reactive protein, a molecule associated with inflammation, were significantly lower in those who got the statin, he noted, and the drug also acts on clot-forming blood platelet cells and improves the function of the endothelium, the sensitive layer of cells that lines the arteries.

"These findings have the potential to change current clinical practice," Di Sciascio said. "They may support the routine use of statin reloading."

But the trial was relatively small, and its results would have to be repeated in larger studies to justify the routine use of statins before PCI, he said.

More information

The U.S. National Heart, Lung, and Blood Institute has more about statins.



SOURCES: Carlo Briguori, M.D., Ph.D., cardiologist, Clinica Mediterranea, Naples, Italy; Germano Di Sciascio, chairman, cardiology, University of Rome; March 30, 2009, presentations, American College of Cardiology annual meeting, Orlando, Fla.


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