Study suggests immediate statins for heart attack patients

“Other studies have indicated a benefit for heart attack patients in beginning treatment with statins relatively early, so today the standard practice is to prescribe them upon discharge,” says R. Scott Wright, M.D., the Mayo Clinic cardiologist who was the study’s lead investigator in North America. “Our new findings suggest they should be given even earlier, as soon as the patient arrives at the hospital.”

The PRINCESS Trial (The PRevention of Ischemic EveNts by Early Treatment of CErivaStatin Study) was designed to test whether very early initiation of statin therapy in hospitalized heart attack patients would prevent deaths and additional heart attacks and reduce the need for bypass surgery or angioplasty.

Within 48 hours of hospitalization, 3,605 patients at 260 medical centers in Europe, Israel, Canada and the United States were randomly assigned to receive either cerivastatin, a potent statin agent, or a placebo. Neither patients nor their physicians knew whether they were receiving the statin or the sugar pill initially, but all of the patients were switched to the statin after three months. Because statins had been proven beneficial as a later-term treatment, withholding the cholesterol-lowering medication for a prolonged period would have been unethical. In the midst of the study, however, cerivastatin’s manufacturer withdrew it from the market due to safety concerns, so the researchers were only able to follow the participants for 4.5 months.

The 1,795 patients initially taking the statin were significantly more likely to reach target levels for LDL (bad) cholesterol, and significantly less likely to have another heart attack or to need surgical or catheter-based interventions to improve blood flow to their hearts during the 4.5 months of follow up.

Dr. Wright says the current study confirms Mayo Clinic’s findings from a retrospective study published in 2001, and indicates that the patient benefits observed are not limited to this particular drug (which is no longer on the market), but are a class effect for statins as a whole. “It is highly unlikely that these results would only apply to cerivastatin, because our previous retrospective study that showed similar benefits involved patients taking a variety of statins,” Dr. Wright explains. “By the same token, this broad-based study involving hundreds of hospitals shows that the gains from early statin therapy are not unique to academic medical centers like Mayo Clinic, but can be realized everywhere.

“Physicians should begin treatment of heart attack patients with statins as soon as possible upon admission to the hospital,” says Dr. Wright. “And patients should see these results as another reason for them to adhere to the statin therapy prescribed by their physicians.”