Adjunctive interventions in myocardial infarction: the role of statin therapy.
Statin therapy has reduced cardiovascular morbidity and mortality across the spectrum of atherosclerosis. The administration of statins has been demonstrated to be effective in primary and secondary prevention clinical trials evaluating patients with high and low risk-factor profiles. The presumed mechanism of benefit of hypolipidemic therapy in the prevention of atherosclerotic disease was a reduction in the deposition of atherogenic lipoproteins in vulnerable areas of the coronary vasculature. Subsequent experimental studies with statins demonstrated a variety of potentially beneficial effects that would extend clinical benefit beyond lipid-lowering per se. Statin therapy beneficially alters inflammation, coagulation and fibrinolytic parameters, endothelial function, vasoreactivity, and platelet function. The demonstration of the non-lipid or pleiotropic effects provided the theoretical basis for a possible role as an adjunctive therapy in acute coronary syndromes. Retrospective analysis of a variety of early trials indicated a potential benefit of statins during acute ischemic syndromes. Recent clinical trials have addressed this important clinical question in a prospective controlled manner. The Myocardial Ischemia Reduction with Aggressive Cholesterol Lowering (MIRACL) and the Thrombolysis In Myocardial Infarction (TIMI)-22 studies present strong clinical evidence in favor of the administration of statins as adjunctive therapy in acute ischemic syndromes.
Jones
Peter H
PH
Section of Cardiology, Department of Medicine, Baylor College of Medicine, One Baylor Plaza, Room 525D, Houston, TX 77030, USA.
Farmer
John A
JA
D054058:Acute Coronary Syndrome / Q000188:drug therapy; D000924:Anticholesteremic Agents / Q000494:pharmacology / Q000627:therapeutic use; D000069059:Atorvastatin; D003324:Coronary Artery Disease / Q000473:pathology / Q000517:prevention & control*; D003326:Coronary Circulation / Q000187:drug effects; D054059:Coronary Occlusion / Q000473:pathology; D050171:Dyslipidemias / Q000188:drug therapy; D004730:Endothelium, Vascular / Q000187:drug effects / Q000503:physiopathology; D006538:Heptanoic Acids / Q000494:pharmacology / Q000627:therapeutic use; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000494:pharmacology / Q000627:therapeutic use*; D009203:Myocardial Infarction / Q000188:drug therapy / Q000503:physiopathology / Q000517:prevention & control*; D017395:Plasminogen Activator Inhibitor 1 / Q000097:blood; D017035:Pravastatin / Q000494:pharmacology / Q000627:therapeutic use; D011758:Pyrroles / Q000494:pharmacology / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic
D000924:Anticholesteremic Agents; D006538:Heptanoic Acids; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D017395:Plasminogen Activator Inhibitor 1; D011758:Pyrroles; D000069059:Atorvastatin; D017035:Pravastatin