Stopping statins may increase heart attack risks

May 1, 2002

Pharmaceutical Representative

Heart disease patients who discontinued using cholesterol-lowering drugs while they were hospitalized for chest pain had triple the risk of death or heart attack compared with people who kept taking their medicine, according to a study in the journal Circulation.

Heart disease patients who discontinued using cholesterol-lowering drugs while they were hospitalized for chest pain had triple the risk of death or heart attack compared with people who kept taking their medicine, according to a study in the March 5 rapid access version of the journal Circulation.

"The message to physicians is: Don't stop statins," said Christian W. Hamm, one of the study authors. "Withdrawal of statin therapy shortly after the onset of symptoms completely eliminated the protective effect of statins in coronary heart disease patients hospitalized with severe chest pain."

An increase in risks

The researchers examined the medical records of 1,616 patients who had previously participated in an international clinical trial called the Platelet Receptor Inhibition in Ischemic Syndrome Management Study. The study compared the effectiveness of two blood-thinning drugs - tirofiban versus heparin - in coronary heart disease patients hospitalized with accelerating heart pain.

When admitted to the hospital, 465 patients had been taking a statin drug for six months. Statin therapy was continued in 379 patients and discontinued in 86. After the 30-day point, researchers examined the rates of death and nonfatal heart attacks. Patients who were kept on their medication had half (0.49 times) the risk of death or a nonfatal heart attack of people who had never taken a statin drug. Those who were not continued on the drugs after hospitalization had 2.93 times the risk of those who continued taking statins.

"The increase in deaths and acute heart attacks was only explained by the statin withdrawal," said Hamm.

Moreover, one week after hospitalization, compared with patients who stayed on their medication, a significantly higher number of patients who were taken off their medication had undergone a procedure to restore blood flow through their coronary arteries.

Hamm says there is no specific protocol suggesting hospitalized patients discontinue statin drugs, so physicians either assumed that statins were no longer beneficial or they simply forgot to continue the medication.

The statin market

Three drugs accounted for 94.5% of the statins prescribed for the patients: Whitehouse Station, NJ-based Merck & Co. Inc.'s Zocor® (simvastatin) (50%), Mevacor® (lovastatin) (24.1%), also marketed by Merck, and New York-based Bristol-Myers Squibb Co.'s Pravachol® (pravastatin sodium) (20.4%).

"All the statins appeared to provide a similar protective effect when patients were pretreated for at least six months prior to hospitalization," said Hamm. "There was no evidence that the discontinuation of the statins was related to the risk profile of the patients. Risk factors, including baseline cholesterol levels and troponin T levels at the beginning of the study, were similar in patients who remained on statins and those who stopped taking statins after admission."

Troponin T is a protein released by heart cells damaged because they do not get enough oxygen. Evaluating the protein in the blood of someone with accelerating chest pain provides a good indication of whether the patient is likely to suffer a heart attack in the near future. PR

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