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Review Questions Statins in Acute Coronary Syndrome

Last Updated: September 30, 2009.

Currently, evidence doesn't appear to support the American College of Cardiology/American Heart Association's Class I, Level of Evidence: A recommendation for initiating statin therapy in patients before discharge following an acute coronary syndrome episode, according to a commentary in the Oct. 6 Journal of the American College of Cardiology.

WEDNESDAY, Sept. 30 (HealthDay News) -- Currently, evidence doesn't appear to support the American College of Cardiology/American Heart Association's Class I, Level of Evidence: A recommendation for initiating statin therapy in patients before discharge following an acute coronary syndrome episode, according to a commentary in the Oct. 6 Journal of the American College of Cardiology.

Ryan P. Morrissey, M.D., of the Cedars-Sinai Medical Center in Los Angeles, and colleagues note that the guidelines make this recommendation regardless of the patient's baseline low-density lipoprotein (LDL) level, with an LDL target level of less than 100 mg/dL, or even 70 mg/dL.

The authors write that the recommendation's disregard for baseline LDL levels is not based on prospective randomized controlled studies. In addition, evidence is insufficient to recommend treating patients to the LDL targets provided in the guidelines. Despite the evidence that early initiation of high-dose statins decreases ischemia and may reduce the risk of revascularization, it didn't reduce myocardial infarctions, and it wasn't associated with a short-term mortality benefit, they write. Plus adverse outcomes involving the liver or muscles may lead to poor long-term adherence.

"We disagree with their [Morrissey et al] conclusions and with their interpretation of the facts. Their choice, to attack this recommendation from among so many easier targets, seems quixotic," write David D. Waters, M.D., and Ivy Ku, M.D., of San Francisco General Hospital, in an accompanying article. "Comprehensive treatment programs in acute coronary syndrome patients that include initiation of statins before hospital discharge have been shown to improve outcomes."

A co-author of the first article reported financial relationships with Schering-Plough and Merck. A co-author of the accompanying article reported financial relationships with a number of pharmaceutical companies.

Abstract - Morrissey
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Abstract - Waters & Ku
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