Statins are cholesterol-lowering drugs, highly effective in the primary and secondary prevention of coronary artery disease. It has been found, however, that statins also have nonlipid effects; they can influence different pathways, which have been described to participate in the pathogenesis of acute coronary syndrome (ACS). Inflammation or decreased production of nitric oxide are obvious targets for statin therapy. Recently, several large clinical trials have been published, showing safety and, in some areas, efficacy of administration of statins early after ACS. Furthermore, there is growing evidence from both experimental and small clinical studies that statin therapy may have favourable effects when started as soon as possible after the development of ACS. Confirmation of this approach by large randomized trials is needed; however, based on currently available data, statins have high chance of achieving a similar place in the first-line therapy of ACS as the pillar of contemporary therapeutic strategy, aspirin.
#1Petr Ostadal(Charles University in Prague)H-Index: 19
#2David Alan(Charles University in Prague)H-Index: 6
Last. Jana Cepova(Charles University in Prague)H-Index: 7
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Background: Activation of inflammatory pathways plays an important contributory role in coronary plaque instability and subsequent rupture, which can lead to the development of acute coronary syndrome (ACS). Elevated levels of serum inflammatory markers such as C-reactive protein (CRP) represent independent risk factors for further cardiovascular events. Recent evidence indicates that in addition to lowering cholesterol levels, statins also decrease levels of inflammatory markers. Previous contr...
Aims Peri-procedural non-Q-wave myocardial infarction is a frequent and prognostically important complication of percutaneous coronary intervention (PCI). It has been postulated that statins may reduce the rate of myocardial injury after PCI. Methods and Results Four hundred and fifty-one patients scheduled for elective PCI and not on statins were randomly assigned to either no treatment or to statin treatment. Statin administration was started at least 3 days before the procedure. Incidence of ...
ContextLimited data are available evaluating how the timing and intensity of statin therapy following an acute coronary syndrome (ACS) event affect clinical outcome.ObjectiveTo compare early initiation of an intensive statin regimen with delayed initiation of a less intensive regimen in patients with ACS.Design, Setting, and ParticipantsInternational, randomized, double-blind trial of patients with ACS receiving 40 mg/d of simvastatin for 1 month followed by 80 mg/d thereafter (n = 2265) compare...
AbstractLong-term pretreatment with statins reduces myocardial injury after acute ischemia and reperfusion by increasing the expression of endothelial nitric oxide synthase (eNOS). We hypothesized that statins may act rapidly enough to protect the myocardium from ischemia/reperfusion injury when giv
Last. Phillip J. Harris(RPA: Royal Prince Alfred Hospital)H-Index: 16
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Abstract Background The efficacy of statin drugs after an acute coronary event is now well established, but the evidence for statin use in the early treatment of acute coronary events remains unclear. Methods We tested the effects of administering pravastatin within 24 hours of the onset of symptoms in patients with unstable angina, non–ST-segment elevation myocardial infarction, or ST-segment elevation myocardial infarction. Patient recruitment of 10,000 with 1200 end points was planned, but th...
#2Peter Libby(Brigham and Women's Hospital)H-Index: 238
Vascular inflammation not only plays a major role in the development of coronary atherosclerosis, but also contributes to the acute onset of thrombotic complications such as myocardial infarction, a leading cause of death in the United States [1]. Despite a gradual decrease in age-adjusted mortality attributable to acute myocardial infarction in the United States, cardiovascular disease is on the rise in many other countries. Macrophage accumulation and consequent production of proteolytic and t...
background Lipid-lowering therapy with statins reduces the risk of cardiovascular events, but the optimal level of low-density lipoprotein (LDL) cholesterol is unclear. methods We enrolled 4162 patients who had been hospitalized for an acute coronary syndrome within the preceding 10 days and compared 40 mg of pravastatin daily (standard therapy) with 80 mg of atorvastatin daily (intensive therapy). The primary end point was a composite of death from any cause, myocardial infarction, documented u...
Background— Inflammation promotes acute coronary syndromes and ensuing clinical complications. Although statins reduce inflammatory markers in asymptomatic adults or in patients with stable angina, the effect of statins on the markedly heightened inflammation in patients with acute coronary syndromes is unknown. Methods and Results— We measured C-reactive protein (CRP), serum amyloid A (SAA), and interleukin 6 (IL-6) in 2402 subjects enrolled the Myocardial Ischemia Reduction with Aggressive Cho...
Abstract Background: The current wisdom is that destabilization of human atheromatous fibroinflammatory plaques may result in thrombosis and is responsible for most acute ischemic syndromes. This paradigm has led to vigorous research to understand the pathogenesis of plaque vulnerability and subsequent rupture, to find reliable systemic serological markers and to identify imaging techniques in order to determine vulnerability of individual plaques. Methods: Research examining the pathobiology of...
Abstract Background and aims There is inadequate evidence to establish statin treatment for primary prevention in the elderly. This study evaluated whether statins are beneficial for primary prevention of cardiovascular disease (CVD) and all-cause death in adults aged ≥ 75 years. Methods A nationwide, nested case-control study was conducted in Korea. Individuals who developed CVD, including myocardial infarction (MI), stroke, or death from all causes, were matched to controls based on duration o...
It has repeatedly been shown that statins decrease morbidity and mortality in patients with atherosclerosis, thus supporting their use for the primary and secondary prevention of ischemic heart disease. Different pathological pathways that are triggered in the setting of acute coronary syndrome (ACS), such as endothelial dysfunction, activation of inflammatory and coagulation cascades, and thrombus formation, are known to be inhibited by statins, thereby justifying the use of these agents in pat...
#1Petr Ostadal(Charles University in Prague)H-Index: 19
#2David Alan(Charles University in Prague)H-Index: 6
Last. Æ Jan Vojacek(Charles University in Prague)H-Index: 1
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It is widely assumed that acute benefit of statin therapy is mediated especially by non-lipid effects. The immediate influence of statins on lipid levels in patients with acute coronary syndrome (ACS) is, however, not clear. A total of 64 consecutive patients with ACS were randomized at admission to fluvastatin 80 mg (Group 1, N = 32) or standard therapy without statin (Group 2, N = 32). The levels of total cholesterol (TC), low-density-lipoprotein cholesterol (LDL-C), high-density-lipoprotein c...
