Am Fam Physician. 2003;67(3):600-602
The use of 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) has been proved to reduce the risk of cardiovascular events, as a primary prevention before disease develops and as a secondary prevention. This prevention benefit appears to be a direct result of the lipid-lowering properties of this class of medications. Recent studies have suggested that, independent of their lipid-lowering properties, statins may benefit patients with coronary artery disease. It is still unclear what benefit statins may provide to patients who undergo percutaneous coronary artery stenting. Schömig and colleagues assessed the influence of statin therapy on one-year survival rates when given after coronary artery stenting.
The study population was a consecutive series of patients who underwent coronary artery stenting. Stent placement was performed based on standard protocols. The use of statins in these patients was based on their clinicians' judgment. Data were collected by telephone interview at one month, a clinic visit at six months, and a telephone interview at 12 months after the procedure. In addition, all hospital readmission information was recorded.
Of the 4,520 patients included in the study, 3,585 received statin therapy after the stenting procedure. The mortality rate in patients who received statins was substantially lower at one year than the rate in those who did not receive statins. This accounted for a 54 percent reduction in the risk of death at one year in those who were treated with statins. Patients with cholesterol levels of 200 mg per dL (5 mmol per L) or lower also benefited from statin therapy.
The authors conclude that the use of statins in patients who have undergone coronary artery stenting improves one-year survival rates. Improvement also occurs in patients whose cholesterol levels are 200 mg per dL or less. Based on this study and other studies of secondary prevention of cardiovascular events with statin use, all patients who undergo coronary artery stenting should be placed on statin therapy unless they have an absolute contraindication to this medication.