Can a big first dose of atorvastatin lower poor outcomes in patients with heart attacks?

The aim of this study was to investigate if a large first dose (loading dose) of atorvastatin (Lipitor) can reduce major adverse cardiovascular events (MACE) in patients with heart attacks and unstable angina.

Acute coronary syndrome (ACS) is a term which describes heart attacks and unstable angina A heart attack is a full blockage in the blood vessels that supply the heart muscle. Unstable angina is a partial blockage of the blood vessels to the heart muscle. The blockages are normally made up of cholesterol plaques. Therefore, the treatment for ACS is the placing of stents in these blood vessels to keep them open. People with ACS are at risk for MACE. MACE includes further heart attacks, rehospitalization, the need for further surgeries on the stents and strokes.

Atorvastatin is a drug that lowers cholesterol and is given after the placing of stents. The patient takes atorvastatin for the rest of their life to prevent further blockages. It is unknown whether giving a large first dose (80mg) of atorvastatin can reduce MACE after stent placement.

This study analyzed 13 different trials including 22,095 patients with ACS. These studies compared giving a loading dose (LD) of atorvastatin (80mg; 50.7% of patients) to standard therapy (control; 49.3% of patients).

Patients who received LD atorvastatin had a 34% reduction in MACE compared to the control groups. Patients who received LD atorvastatin were 39% less likely to have further heart attacks, 31% less likely to have a stroke. They were also 24% less likely to need further procedures on the blood vessels with stents compared to the control groups. There was no difference in risk of death or rehospitalization between the two groups.

MACE risk within the first 30 days was 43% lower in patients with LD atorvastatin. Further heart attacks were also 39% lower in the first 30 days in this group. After more than 30 days, LD atorvastatin still significantly reduced MACE (by 30%), further heart attacks (by 42%) and further procedures (by 24%).

The authors concluded that a loading dose (80mg) of atorvastatin significantly lowers cardiovascular events in patients with ACS.

This study did not take into account risk factors for MACE such as older age, high blood pressure, diabetes, number of stents and of blood vessels affected. This might have changed the results.