High Intensity Statin in Patient with Acute Coronary Syndrome, Why and How?
Author : Mohammad Saifur Rohman
Upload Date : 19-04-2018
Statins were introduced to clinical practice as lipid-lowering drugs for the treatment of high blood cholesterol levels. Their efficacy in secondary prevention was demonstrated in large prospective morbidity and mortality clinical trials involving patients with stable coronary artery disease (CAD). Later, statins may significantly contribute to plaque stabilization, reduction of thrombus formation and acceleration of fibrinolysis suggesting a rational use of statin in acute coronary syndrome (ACS).
Several randomized trials have demonstrated the safety and, in some cases, the efficacy of statin therapy if initiated early after the onset of ACS. Recent experimental studies, similar to the first clinical trials, have generated promising results that have supported the concept of the cardioprotective effect of statin administration as first-line therapy for ACS.
Furthermore, the previous study showed ACS patients with diabetes melitus, high intensity statin induced better long-term outcomes compared with moderate intensity. Several randomized controlled trials have also shown a benefit of high intensity statin treatment in reducing risk of death and second cardiovascular disease (CVD) events in patients previously diagnosed with an acute coronary syndrome (ACS).
The mechanism of these benefit showed by a meta-analysis involving 1623 participants from eight randomized-controlled trials and seven observational studies revealing that the benefits of high-intensity statin therapy on plaque regression occurred after 6 months [standardized mean difference (SMD): -0.27; 95% confidence interval (CI): -0.43 to -0.12; P=0.0006] and were sustained over 12 months (SMD: -0.14; 95% CI: -0.25 to -0.03; P=0.01).
How long high intensity statin used after an ACS, statin should be continued for at least 5 years. High-dose statin demonstrated a reduction in coronary events but dose reductions and higher discontinuation rates were also noted.
KEYWORDS : High intensity statin, acute coronary syndrome, plaque regression
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