Hospital Heart Patients Should Not Stop Statin Therapy

A study has found that patients with heart disease who discontinue cholesterol-lowering drugs (simvastatin, lovastatin, pravastatin) while hospitalized for chest pain had a risk of death or heart attack three times that of people who kept taking their medication. The study was published in the March 4, 2002, rapid access issue of Circulation.

Researchers at the Kerckhoff Heart Center in Bad Nauheim (Germany) examined the medical records of 1,616 heart patients. When admitted to the hospital, 465 patients had been taking a statin drug for six months. The therapy was continued in 379 patients and discontinued in 86. After 30 days, the researchers examined the rates of death and nonfatal heart attacks. They found that patients who were kept on their medication had a risk of death or nonfatal heart attack that was only half that of patients who had never taken a statin drug. Moreover, the risk for patients who were not continued on a statin drug after hospital admission had almost three times the risk of those who continued taking the drug. In addition, a significantly higher number of patients who were taken off their medication had to undergo a procedure to restore blood flow through their coronary arteries.

The researchers say statins appear to do more than merely lower cholesterol. They reduce inflammation and the proliferation of smooth muscle cells in the arteries. They also increase the release of protective nitric oxide from heart cells. Animal research showed that suddenly withdrawing statins causes a rebound effect, causing the level of nitric oxide to drop below normal.

"There was no evidence that the discontinuation of the statins was related to the risk profile of the patients. Risk factors, including baseline cholesterol levels and troponin T levels at the beginning of the study were similar in patients who remained on statins and those who stopped taking statins after admission,” said Christian W. Hamm, M.D., one of the authors of the study.