Experts question study on statins, heart patients
The dramatic lowering of death rates was 'too good to be true,' one doctor said.
LOS ANGELES TIMES
Giving statin drugs within 24 hours of a heart attack decreases the short-term death rate by more than 50 percent, according to a study published Monday.
The study suggests that statins, now widely used to lower cholesterol levels, might have a powerful effect in decreasing the heart muscle inflammation that occurs immediately after an attack.
But several statin experts expressed doubt about the dramatic results, arguing that the study was poorly conceived.
"The idea that you would see such a huge benefit so quickly is hard to accept," said Dr. Steven Nissen, a statin expert at the Cleveland Clinic Foundation and a well-known advocate of the drugs.
Lead researcher Dr. Gregg Fonarow, a professor of cardiology at UCLA, said he, too, was surprised by the study's results, but "this is what we observed in 170,000 patients."
"This is the first large-scale study looking at this protective effect," he said.
Fonarow said a controlled clinical trial would be needed to confirm the findings, published in the American Journal of Cardiology.
Details of study
The researchers analyzed data from 174,635 heart attacks compiled as part of a national registry from July 2000 to January 2002.
Compared with patients who never took the drugs, heart attack victims who had been on statins and continued them without interruption had a 54 percent lower death rate. The reduction was 58 percent for patients who first started taking the drugs within 24 hours of their attacks.
For patients who had been on the drugs but did not take them immediately after their heart attacks, the death rate rose 25 percent over patients who had never been on the drugs.
Dr. P.K. Shaw, a UCLA professor and director of cardiology at Cedars-Sinai Medical Center in Los Angeles, called the results "almost too good to be true."
He questioned the mechanism that the authors proposed to explain their findings.
"Whether you get a benefit in the first 24 hours is pretty dubious," Shaw said.
Dr. Bruce Psaty, a University of Washington epidemiologist, said he believed the results were flawed because there were too many factors complicating the analysis.
For example, the most critically ill patients, whose treatment is focused on preventing imminent death, were probably the least likely to be prescribed a pill immediately after admission to the hospital, he said.
Known as an observational study, the new research relies on an analysis of previously collected data.