Early Time to Benefit with Intensive Statin Treatment: Could It Be the Pleiotropic Effects?

Acute coronary syndrome (ACS) is associated with a number of abnormalities in inflammation, endothelial function, and coagulation, all of which appear to be modulated by statins. We examined the time to benefit of different statin regimens in the Pravastatin or Atorvastatin Evaluation and Infection Therapy–Thrombolysis in Myocardial Infarction 22 (PROVE IT–TIMI 22) trial and other ACS trials that compared statin therapies in patients with ACS. In PROVE IT–TIMI 22, apparent clinical benefit was observed as early as 30 days, with significant reduction in all-cause mortality, myocardial infarction, unstable angina requiring rehospitalization, revascularization performed 30 days postrandomization, or stroke observed as early as 4 months. In PROVE IT–TIMI 22, atorvastatin 80 mg lowered both low-density lipoprotein (LDL) cholesterol and C-reactive protein (CRP) at 30 days and 4 months to a greater extent than pravastatin 40 mg. Those who achieved the lowest LDL and the lowest CRP levels at 30 days after ACS had the lowest risk of acute cardiac events. The very early benefits of statin therapy appeared to be correlated with CRP reductions, which may relate to the intensity of the pleiotropic effects of statins.