Abstract
Secondary prevention of coronary heart disease by antilipidemic therapy beginning
at ≥3 months after an acute coronary syndrome is well documented. The impact, however,
of immediate initiation of antilipidemic therapy on coronary stenoses and clinical
outcome in patients with acute coronary syndrome is unknown. In our study, patients
were randomized, on average, 6 days after an acute myocardial infarction and/or percutaneous
transluminal coronary angioplasty secondary to unstable angina, to pravastatin (combined,
when necessary, with cholestyramine and/or nicotinic acid) to achieve low-density
lipoprotein cholesterol levels of ≤130 mg/dl (group A, n = 70). In controls (group
B, n = 56), antilipidemic therapy was determined by family physicians. Quantitative
coronary angiography was performed at inclusion, and at 6- and 24-month follow-up.
The combined clinical end points were total mortality, cardiovascular death, nonfatal
myocardial infarction, need for coronary intervention, stroke, and new onset of peripheral
vascular disease. Minimal lumen diameter in group A increased by 0.05 ± 0.20 mm after
6 months and 0.13 ± 0.29 mm after 24 months, whereas it decreased by 0.08 ± 0.20 mm
and 0.18 ± 0.27 mm, respectively, in group B (p = 0.004 at 6 months and p <0.001 at
24 months). After 2 years, 29 patients of 56 patients in group B, but only 16 of 70
patients in group A, experienced a clinical end point (p = 0.005; odds ratio 0.28,
confidence intervals 0.13 to 0.6). We conclude that pravastatin-based therapy initiated
immediately after an acute coronary syndrome is well tolerated and safe, lessens coronary
atherosclerosis, and has a pronounced clinical benefit.
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Article info
Footnotes
☆This study was supported in part by a grant from Bristol-Myers Squibb Company, Munich, Germany. Manuscript received February 14, 2000; revised manuscript received and accepted June 20, 2000.
Identification
Copyright
© 2000 Excerpta Medica Inc. Published by Elsevier Inc. All rights reserved.
