Thursday, August 26, 2010

Some more indications for Statin

As we all know, we are getting more and more new information on the benefits of Statins independent from their ability to inhibit HMG CoA reductase and reduce LDL cholesterol. 


There has been a great interest in high CRP levels and their relation to increased coronary events, even in the absence of hyperlipidemia. The study done on nearly 500 patients who had MI showed nicely that Pravastatin reduced the median and mean CRP levels significantly, compared to placebo, over a period of 5 years.(E.Braunwald - same person who contributed a lot to Harrison's Textbook). With this background, PROVE IT-TIMI 22 trial recruited nearly 4000 pts, and showed that pts with low CRP levels after statin therapy have a better clinical outcome than if CRP level is high. 
Given these stimulating results, investigators tried to apply this in the primary prevention of CAD. And guess what...two studies with slightly different population (AFCAPS- low risk pts, and JUPITER- intermediate and high risk ...due to 10% 10 yr Framingham risk score) showed significant reduction in the first coronary event in patients whose CRP level decreased while on statin. All the participants didn't have hyperlipidemia. The Canadian Heart Guidelines have already included CRP in risk stratifying pts for primary prvention. 


Statins also reduce the incidence of DVT/PE as shown in a meta analysis of nearly 1 million pts done at U Conn. JUPITER trial was included in this meta analysis, as this is the only randomised trial to show reduction in DVT ( but not significant for reduction in PE).


Now this is the latest on the list of benefits from Statin ---- A meta analysis looking at incidence of ventricular arrhythmias(VF/VT) among pts with CAD on a statin Vs no statin, has shown a 31% reduction in ventricular arrhythmic events in the statin group. This has previously been shown in a subgroup from MADIT-II trial.
So ...what about Atrial Fibrillation. Well there were many studies on Statins and maintaining sinus rythm in A fib...with conflicting results. A recent meta analysis showed that Statins does not help maintain sinus rythm in patients who underwent elective DC cardioversion. 


This list of benefits might increase every day....... keep checking!!

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