Sunday, March 26, 2006

Is there a pleothrophic effect of Statins

At the just concluded American College of Cardiology Annual Scientific meeting, the results of ASTEROID was presented. ASTEROID, discussed earlier, was an intravascular ultrasound study, lead by ACC president-elect Dr Steve Nissen, where 507 patients on Crestor 40mg showed atheroma regression, at the end of 24 months. This study, follows an eaarlier study by Pfizer called "REVERSAL" where high dose Lipitor (80 mg), also showed atheroma non-progression or regression when compared to Pravachol 40 mg.

Neither of these are clinical events study, which is a clinicians main concern. The link seem to be "PROVE IT-TIMI 22" where high dose Lipitor 40 mg showed significant MACE reductions when compared to Pravachol 40 mg. What was interesting is that from "PROVE IT-TIMI 22"we know that the patients on Lipitor 40 mg, who had high LDL-C but low hs-CRP suggesting that lowering hs-CRP may be as important as lowering LDL-Cholesterol? What was important also was that the events reduction in the high Lipitor group came as early as 30 days after the start of Lipitor, remembering that earlier studies of cholesterol lowering, for example with ileal-bypass, showed LDL-cholesterol reduction with cardiac events reduction, but these came 1-2 years after the ileal-bypass. Does this mean that lower LDL-C was not responsible for the hs-CRP and events reduction, but that pleotrophic effects of "Statins" may be rsponsible.

Interesting thought, "Are the good effects of STATINS in lowering MACE in patients with CAD, due to it's LDL-Cholesterol effects, or due to it's pleotrophic, extra-cholesterol effects? What do you think?

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