Stopping statins may be dangerous
By DrRich
Dateline: March 11, 2002
In last week's issue of Circulation, researchers reported that patients whose statin drugs were discontinued during hospitalization for chest pain had three times the risk of dying as patients whose statin drugs were continued.
Researchers came to this conclusion by examining the hospital records of over 1600 patients who had participated in another research trial (the PRISM trial, which evaluated two different blood thinners in patients with coronary artery disease.) Of these patients, 465 had been taking a statin drug for at least 6 months. The statins were continued during hospitalization in 379, and discontinued in 86. The 86 patients whose statins were stopped had triple the risk of dying of heart attack as the 379 patients who were continued on statins. (Doctors apparently stopped statins in these 86 patients because they did not believe the drugs would be of any further help, or they simply overlooked the fact that the patient had been on statins prior to hospitalization.)
Furthermore, of the original 1600 patients, 165 who had never been given statins were started on statins at the time of hospital admission. These patients had fewer deaths and heart attacks than patients who never received statins.
Why did these patients die when statins were stopped?
Statins are the most common drugs used for reducing cholesterol levels. Since cholesterol promotes damage to blood vessels gradually, over a long period of time, there would seem to be no reason to predict that using statins would reduce the risk of death acutely (that is, over a single hospitalization.) So why did the failure to continue (or to initiate) statin therapy at the time of hospitalization for coronary artery disease increase the risk of death?
The answer appears to be that statins do far more than merely reduce cholesterol levels. Recent evidence suggests that statins reduce inflammation within arteries (now thought to be an important factor in causing arteries to occlude.) They also reduce the "stickiness" of platelets. (Platelets are the blood elements that most immediately cause a diseased artery to occlude suddenly.) Statins are thought to have other beneficial effects on the walls of the coronary arteries that result in the "stabilization" of an artery that is threatening to occlude.
This recent study strongly suggests that prior observations suggesting that statins might have direct beneficial effects on unstable coronary arteries are more than mere laboratory observations - they appear to translate into important and striking clinical benefits.
What this means to you
If you are taking statins and are admitted to the hospital for chest pain, make sure your doctor does not stop your medication during the hospitalization. And if you are admitted for probable coronary artery disease and are not taking a statin drug, ask your doctor to start one. Remember: in this instance you are not so much concerned about your long-term cholesterol levels as you are about getting out of the hospital alive.
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