The immediate use of statins after heart attack reduces chance of stroke

THE QUESTION Does immediate lowering of cholesterol affect the risk of stroke in people with heart disease?

PAST STUDIES have suggested that reducing blood cholesterol levels after a heart attack may lessen a survivor's high risk for stroke. In these studies, however, treatment with cholesterol-lowering drugs did not begin until a few months after the heart attack.

THIS STUDY compared the risk of stroke in 3,086 patients with chest pain or heart attack who received either 80 milligrams daily of the cholesterol-lowering drug atorvastatin (Lipitor) or a placebo within four days of hospitalization. People in both groups also received advice about a cholesterol-reducing diet.

The average level of the participants' LDL, or "bad," cholesterol at the beginning of the study was 124 milligrams per deciliter. (Healthy levels are under 100.) In the next four months, LDL levels rose slightly in the placebo group but decreased by 40 percent in the treatment group, to an average of 72. Half as many patients who took atorvastatin had strokes (12, three of them fatal) as did patients who took the placebo (24, two fatal).

WHO MAY BE AFFECTED BY THESE FINDINGS? People hospitalized for chest pain or heart attack.

CAVEATS Pfizer, the manufacturer of Lipitor, funded the study. Also, the results need to be verified in more people and for a longer time. Finally, other statins may have different effects.

BOTTOM LINE People hospitalized with chest pain or a heart attack may wish to consult their physician about using statins immediately.

FIND THIS STUDY Sept. 3 issue of the rapid access edition of Circulation; abstract online at ahajournals.org/journal/circ.

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