Published online before print October 11, 2004, doi: 10.1161/01.CIR.0000145118.55201.15
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(Circulation. 2004;110:2333-2335.)
© 2004 American Heart Association, Inc.
Coronary Heart Disease |
There Is No Evidence for an Increase in Acute Coronary Syndromes After Short-Term Abrupt Discontinuation of Statins in Stable Cardiac Patients
From the New England Heart Institute, Manchester, NH.
Correspondence to Mary P. McGowan, MD, New England Heart Institute, 100 McGregor St, Manchester, NH 03102. E-mail mmcgowan{at}cmc-nh.org
Received June 10, 2004; revision received August 13, 2004; accepted August 25, 2004.
Background— For a variety of reasons, many patients abruptly discontinue statin therapy. The present analysis was conducted to determine whether the risk of cardiovascular outcomes increases after withdrawal of statin therapy in a stable cardiac population.
Methods and Results— In the Treating to New Target (TNT) study, 2 doses of atorvastatin (10 and 80 mg once daily) are being used in a double-blind parallel-group design. Of the 18 468 patients screened for study participation, 16 619 entered a dietary lead-in/drug-washout period, and of these, 15 432 eligible participants began treatment with atorvastatin 10 mg/d on an open-label basis. Of the subjects who entered the dietary lead-in/drug-washout period, 57% were receiving prior statin therapy. During the 6-week drug-washout period, there were 24 primary events (defined as coronary heart disease death, nonfatal myocardial infarction, resuscitated cardiac arrest, and fatal or nonfatal stroke); throughout the subsequent 8-week open-label period, there were 31 primary events. This equated to monthly Kaplan-Meier event rates of 0.20% during washout and 0.26% in the open-label phase. Event rates were therefore similar during the 2 phases.
Conclusions— The present analysis demonstrates that short-term discontinuation of statin therapy in stable cardiac patients apparently does not lead to a clinically important increased risk of acute coronary syndromes.
Key Words: coronary disease • statins • drugs • hyperlipoproteinemia
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Circulation 2004 110: 2280-2282.
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