Many With Heart Disease Not Getting Statins
Despite strong evidence that statin therapy reduces cardiovascular morbidity and mortality in patients with coronary artery disease (CAD)—even among patients with low-density lipoprotein (LDL) cholesterol levels <100 mg/ dL—nearly 20% of patients with obstructive CAD are not getting these medications.
A study published in the November 2011 Circulation found that among nearly 39,000 people who had had heart attacks or undergone heart surgery, about 8600 had not been prescribed statins. The patients were part of a national outpatient registry designed to track quality of care in heart patients. None had documented contraindications to statin therapy.
Among these patients, 77.8% were prescribed statins, 5.3% were treated only with nonstatin lipid-lowering medications, and 17.0% were left untreated.
Lack of medical insurance was associated with not being treated with statins; male sex, coexisting hypertension, and a recent coronary revascularization were associated with getting statin treatment.
The study’s lead author, Suzanne Arnold, MD, MHA, of St. Luke’s Mid America Heart Institute in Kansas City, Missouri, noted that half of the untreated patients had low LDL levels.
“This supports the assumption that some doctors may not think patients with low LDL levels need lipid-lowering medication,” she said, even though people with low LDL cholesterol can benefit from statins. “Statins do more than just lower cholesterol. They also play a role in reducing plaque and inflammation in arteries.”
Arnold SV, Spertus JA, Tang F, et al. Statin use in outpatients with obstructive coronary artery disease. [published online ahead of print November 7, 2011]. doi:10.1161/CIRCULATIONAHA .111.038265.
Gout Treatment Reduces Incidence of Postsurgical Atrial Fibrillation
Colchicine greatly reduced the incidence of post-pericardiotomy syndrome and postsurgery atrial fibrillation (AF) by nearly half in a placebo-controlled randomized study presented at the American Heart Association Scientific Sessions 2011.
The Italian study included 336 patients whose average age was 66 years. Researchers found that 1 month after heart surgery, just 12% of those taking colchicine had AF versus 22% of patients taking placebo. The heart surgery patients who received colchicine were also hospitalized for 3 fewer days than those who received a placebo. Side effects were similar in the study and placebo groups.
Study participants started taking colchicine or placebo 3 days postsurgery, continuing for 1 month. Lead author Massimo Imazio, MD, for Maria Vittoria Hospital in Turin, Italy, said colchicine had never before been shown to prevent AF, and that the drug may be an inexpensive and safe option of the prevention of post-pericardiotomy syndrome and postoperative AF. He recommended that large-scale studies initiate colchicine treatment earlier, ideally before surgery.
Imazio M, Brucato A, Ferrazzi P, et al. Colchicine reduces postoperative atrial fibrillation; the results of the Colchicine for the Prevention of Postpericardiotomy Syndrome (COPPS) Atrial Fibrillation Substudy. Circulation. 2011;124:2290-2295.
Human Heart Stem Cells Show Encouraging Results in HF Patients
A pilot study of autologous cardiac stem cells (CSCs) for the treatment of heart failure (HF) resulting from ischemic heart disease has produced encouraging results, suggesting that it may be possible to improve heart function and reverse tissue damage in HF patients with intracoronary infusions of their own stem cells.
University of Louisville researchers led by Roberto Bolli, MD, concluded that intracoronary infusion of autologous CSCs is effective in improving IV systolic function and reducing infarct size in patients with HF after myocardial infarction. The study involved 23 patients with post-infarction left ventricular (LV) dysfunction (ejection fraction [EF] <40%), 16 of whom were assigned to the treatment group and 7 to the control group. In 14 treatment-group patients who were analyzed, LVEF increased from 30.3% before CSC infusion to 38.5% at 4 months postinfusion (P = 0.001). In contrast, in 7 control patients, LVEF did not change.
The healthy effects of CSCs were even more pronounced at 1 year in 8 patients (eg, LVEF increased by 12.3 EF units vs baseline, P = 0.0007), the researchers noted. In the 7 treated patients in whom cardiac MRI could be performed, infarct size decreased from 32.6 g by 7.8 g at 4 months (P = 0.004) and 9.8 g at 1 year (P = 0.04). No CSC-related adverse events were reported.
Bolli R, Chugh AR, D’Amario D, et al. Cardiac stem cells in patients with ischaemic cardiomyopathy (SCIPIO): initial results of a randomized phase 1 trial. Lancet. 2011;378:1847-1857.