There is no evidence for an increase in acute coronary syndromes after short-term abrupt discontinuation of statins in stable cardiac patients.
BACKGROUND
For a variety of reasons, many patients abruptly discontinue statin therapy. The present analysis was conducted to determine whether the risk of cardiovascular outcomes increases after withdrawal of statin therapy in a stable cardiac population.


RESULTS
In the Treating to New Target (TNT) study, 2 doses of atorvastatin (10 and 80 mg once daily) are being used in a double-blind parallel-group design. Of the 18,468 patients screened for study participation, 16,619 entered a dietary lead-in/drug-washout period, and of these, 15,432 eligible participants began treatment with atorvastatin 10 mg/d on an open-label basis. Of the subjects who entered the dietary lead-in/drug-washout period, 57% were receiving prior statin therapy. During the 6-week drug-washout period, there were 24 primary events (defined as coronary heart disease death, nonfatal myocardial infarction, resuscitated cardiac arrest, and fatal or nonfatal stroke); throughout the subsequent 8-week open-label period, there were 31 primary events. This equated to monthly Kaplan-Meier event rates of 0.20% during washout and 0.26% in the open-label phase. Event rates were therefore similar during the 2 phases.


CONCLUSIONS
The present analysis demonstrates that short-term discontinuation of statin therapy in stable cardiac patients apparently does not lead to a clinically important increased risk of acute coronary syndromes.
McGowan
Mary P
MP
New England Heart Institute, 100 McGregor St, Manchester, NH 03102. mmcgowan@cmc-nh.org.
D000208:Acute Disease; D000069059:Atorvastatin; D003327:Coronary Disease / Q000209:etiology / Q000401:mortality; D018572:Disease-Free Survival; D004311:Double-Blind Method; D006323:Heart Arrest / Q000453:epidemiology / Q000209:etiology; D006538:Heptanoic Acids / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D015994:Incidence; D015993:Life Tables; D009203:Myocardial Infarction / Q000453:epidemiology / Q000209:etiology; D017202:Myocardial Ischemia / Q000453:epidemiology / Q000209:etiology*; D011758:Pyrroles / Q000008:administration & dosage / Q000009:adverse effects*; D020521:Stroke / Q000453:epidemiology / Q000209:etiology; D013375:Substance Withdrawal Syndrome / Q000209:etiology*; D013577:Syndrome; D028761:Withholding Treatment
D006538:Heptanoic Acids; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D011758:Pyrroles; D000069059:Atorvastatin