Good news for those concerned about hearts attacks and strokes! Thanks to a statin called Lipitor (atorvastatin), those with unstable angina or non Q-wave acute myocardial infarction (MI) can now have their risks of recurrent ischemic events reduced.

According to Pfizer, the company behind Lipitor, MIRACL (Myocardial Ischemia Reduction with Aggressive Cholesterol Lowering) study employed the most rigorous and reliable of all study design: It was a large, global, prospective, multicenter, randomised, double-blind placebocontrolled trial. The goal of the MlRACL study was to find out if early use of Lipitor could reduce death and non-fatal ischemic events. A total of 3,086 adults aged 18 or older with unstable angina or non-Q-wave acute MI participated in this trial.

Over a period of 16 weeks, the researchers found that early treatment of Lipitor proved effective, reducing recurrent ischemic events among the patients. Death, non- fatal MI and cardiac arrest, as well as strokes, occurred less frequently with those who took Lipitorthan than those who took the placebo.

“Many studies have shown that statins are able to reduce the risks of a second heart attack by as much as 30 to 40 per cent in patients with narrowed heart arteries", said Dr Peter Yan, consultant cardiologist. The issue currently being faced, is whether to put those who have no symptoms of a heart attack onto statins. He said that local guidelines for doctors released by the Ministry of Health recommend that this particular group of patients do a checklist and their scores will determine their risks of a heart attack and whether they should be prescribed with statins by their doctors.

So how do these statins work? In Singapore, there are several statins available including Lipitor. Statins help lower low-density lipoprotein (LDL) cholesterol levels by as much as 60 per cent in patients on these drugs. It also increases slightly high-density lipoprotein (HDL) cholesterol and reduces elevated triglyceride levels. The large reductions in total and LDL cholesterol produced by statins have resulted in lower risks of heart attacks and deaths due to heart disease.

Statins were originally prescribed for those who had coronary artery disease and high cholesterol; this was before recent studies have shown these to be effective in preventing a first heart attack even in people who have normal cholesterol levels and no sign of heart disease.

Statins may slow; stop or even reverse the buildup of plaque. By lowering the cholesterol content in unstable plaques, statins may also make them more stable and less prone to rupture. Statins may also make artery walls healthier by reabsorbing cholesterol from plaques thereby clearing blood vessels. According to Dr Yan, statins have other benefits including anti-inflammatory properties and anti-coagulation properties.

Statins are usually taken in a single dose with the evening meal or at bedtime. It is advisable that these medications be given in the evening to take advantage of the fact that the body makes more cholesterol at night than during the day.

Dr Yan explained that in terms of preventing a heart attack, patients might have to stay on statins for one year to normalise their cholesterol levels. However, those who have had a heart attack previously will need to take the drug for long-term. He added that there are some side effects to the drug such as muscle aches, kidney failure and hepatitis. However these side effects are rare.

Additionally, cancer patients are not advised to take statins as "there is an implication that [the result] of low cholesterol may actually aggravate cancer but this has never been proven," said Dr Yan. Those with chronic hepatitis also should not take statins.

He concluded, "I feel that the development of statins is one of the milestones therapies over the last century in terms of helping cardiologists in battling cardiovascular diseases. With statins, we are able to see a 30-per cent drop in cardiovascular mortality rates."

(By Eleanor Yap. This article first appeared in Parkway Medicine, April 2002)