Search

Context: Patients experience the highest rate of death and recurrent ischemic events during the early period after an acute coronary syndrome, but it is not known whether early initiation of treatment with a statin can reduce the occurrence of these early events.Objective: To determine whether treatment with atorvastatin, 80 mg/d, initiated 24 to 96 hours after an acute coronary syndrome, reduces death and nonfatal ischemic events.Design and Setting: A randomized, double-blind trial conducted from May 1997 to September 1999, with follow-up through 16 weeks at 122 clinical centers in Europe, North America, South Africa, and Australasia.Patients: A total of 3086 adults aged 18 years or older with unstable angina or non-Q-wave acute myocardial infarction.Interventions: Patients were stratified by center and randomly assigned to receive treatment with atorvastatin (80 mg/d) or matching placebo between 24 and 96 hours after hospital admission.Main Outcome Measures: Primary end point event defined as death, nonfatal acute myocardial infarction, cardiac arrest with resuscitation, or recurrent symptomatic myocardial ischemia with objective evidence and requiring emergency rehospitalization.Results: A primary end point event occurred in 228 patients (14.8%) in the atorvastatin group and 269 patients (17.4%) in the placebo group (relative risk [RR], 0.84; 95% confidence interval [CI], 0.70-1.00; P =.048). There were no significant differences in risk of death, nonfatal myocardial infarction, or cardiac arrest between the atorvastatin group and the placebo group, although the atorvastatin group had a lower risk of symptomatic ischemia with objective evidence and requiring emergency rehospitalization (6.2% vs 8.4%; RR, 0.74; 95% CI, 0.57-0.95; P =.02). Likewise, there were no significant differences between the atorvastatin group and the placebo group in the incidence of secondary outcomes of coronary revascularization procedures, worsening heart failure, or worsening angina, although there were fewer strokes in the atorvastatin group than in the placebo group (12 vs 24 events; P =.045). In the atorvastatin group, mean low-density lipoprotein cholesterol level declined from 124 mg/dL (3.2 mmol/L) to 72 mg/dL (1.9 mmol/L). Abnormal liver transaminases (>3 times upper limit of normal) were more common in the atorvastatin group than in the placebo group (2.5% vs 0.6%; P<.001).Conclusion: For patients with acute coronary syndrome, lipid-lowering therapy with atorvastatin, 80 mg/d, reduces recurrent ischemic events in the first 16 weeks, mostly recurrent symptomatic ischemia requiring rehospitalization. [ABSTRACT FROM AUTHOR]

The evidence from formal, controlled, long-term clinical trials that changes in dietary fats reduce the incidence of ischemic (coronary) heart disease (IHD) is unimpressive. Mostly these trials were underpowered and in several the rigor of dietary control in the intervention and control groups was inadequate. Six controlled clinical trials in healthy people of diets low in saturated fat and cholesterol, also accompanied by changes in other risk factors, were unsuccessful in reducing the incidence of IHD. An exception was the Oslo trial in which concurrent cigarette smoking was almost halved. Similarly, in the only two clinical trials of the secondary prevention of IHD through use of diets low in saturated fats and cholesterol there was no significant effect on IHD recurrence rate. This may relate to poor compliance outside strict clinic conditions. In contrast, five of six secondary prevention trials in which diets low in saturated fats were supplemented with polyunsaturated fats reduced IHD deaths and, to a lesser extent, all-cause mortality. No formal trial has been reported of the effects on IHD of diets high in monounsaturated fats. The greatest benefit for patients with IHD has come from diets supplemented with n-3 fatty acids (two trials), and this benefit was independent of changes in plasma lipoproteins. The evidence from these clinical trials indicates that more emphasis should be given in national and international dietary recommendations to supplementation with polyunsaturated fats, particularly foods rich in n-3 fatty acids, than to diets low in total and saturated fats. Copyright (c) 1997 American Society for Clinical Nutrition [ABSTRACT FROM AUTHOR]