Atorvastatin has an important acute anti-inflammatory effect in patients with acute coronary syndrome: results of a randomized, double-blind, placebo-controlled study.
BACKGROUND
C-reactive protein (CRP) levels are associated with cardiovascular risk. We assessed the hypothesis that atorvastatin might have anti-inflammatory effects in acute coronary syndromes (ACS) as shown by CRP reduction.


METHODS
This study was a prospective, randomized, double-blind, placebo-controlled study of 90 consecutive patients admitted within 48 hours of onset of ACS with CRP levels > or =1.4 mg/dL. Patients were assigned to atorvastatin 40 mg daily or placebo over 30 days. C-reactive protein levels, lipid profiles, serum fibrinogen, white cell count, and erythrocyte sedimentation rate were measured at entry, hospital discharge, and 1 month later.


RESULTS
Baseline clinical characteristics did not differ between atorvastatin and placebo groups (mean age 59.3 +/- 13.4 vs 61.1 +/- 11.5, P = ns); myocardial infarction 52.3% versus 67.4% ( P = ns). In both groups, median baseline CRP levels were comparable (5.97 +/- 6.2 vs 4.64 +/- 4.2 mg/dL, P = ns). C-reactive protein levels were lower in the atorvastatin group versus control group at discharge (1.68 +/- 1.65 vs 4.12 +/- 4.18 mg/dL) and at 30 days (0.50 +/- 0.71 vs 2.91 +/- 2.68 mg/dL, both P < .0001). C-reactive protein levels significantly decreased from baseline to discharge and 1 month later in placebo and atorvastatin groups (both P < .0001); however, the reduction was greater in the atorvastatin group (62% vs 11% at discharge [P < .0001]; 84% vs 30% at 1 month [P < .0001]). In addition, atorvastatin was associated with a reduction in total and low-density lipoprotein cholesterol and erythrocyte sedimentation rate at discharge and at 30 days (P < .0001 for all comparisons). No correlation was found between changes in CRP and cholesterol levels.


CONCLUSIONS
C-reactive protein levels in ACS were rapidly reduced with atorvastatin. These data provide evidence that statins have fast and early anti-inflammatory effects in addition to lipid-lowering effects in ACS.
Macin
Stella M
SM
Coronary Intensive Care Unit, Instituto de Cardiología Juana F. Cabral, Corrientes, Argentina. macinucic@hotmail.com
Perna
Eduardo R
ER
Farías
Eduardo F
EF
Franciosi
Valeria
V
Cialzeta
Jorge R
JR
Brizuela
Mónica
M
Medina
Fernanda
F
Tajer
Carlos
C
Doval
Hernan
H
Badaracco
Reynaldo
R
D000208:Acute Disease; D000209:Acute-Phase Proteins / Q000187:drug effects / Q000378:metabolism; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D000069059:Atorvastatin; D015415:Biomarkers / Q000378:metabolism; D002097:C-Reactive Protein / Q000187:drug effects / Q000378:metabolism*; D008078:Cholesterol, LDL / Q000187:drug effects / Q000378:metabolism; D003327:Coronary Disease / Q000150:complications / Q000188:drug therapy* / Q000378:metabolism*; D048909:Diabetes Complications; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D005260:Female; D017408:Guidelines as Topic; D006538:Heptanoic Acids / Q000008:administration & dosage*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage*; D006949:Hyperlipidemias / Q000150:complications; D008055:Lipids / Q000097:blood; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011758:Pyrroles / Q000008:administration & dosage*; D055502:Secondary Prevention; D013577:Syndrome
D000209:Acute-Phase Proteins; D000893:Anti-Inflammatory Agents; D015415:Biomarkers; D008078:Cholesterol, LDL; D006538:Heptanoic Acids; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D008055:Lipids; D011758:Pyrroles; D002097:C-Reactive Protein; D000069059:Atorvastatin