Statins in Acute Coronary Syndrome Use of an Early Loading Dose

Abstract

Aim: It has been observed that in some emergency services it has become a common practice to prescribe a high but variable loading dose of statins to patients with acute myocardial infarction within the first few hours from the onset of symptoms, under the premise that this will help reduce inflammatory mediators and have a positive effect over the endothelium, and by doing so reduce the risk of recurrent ischemic events. To review the scientific evidence that could support this practice and help clarify the optimum dosage.

Methods: For the process of documenting the evidence, we searched through scientific information databases to find sources of primary information, giving emphasis on randomized clinical trials that evaluated the efficacy of statins. We also searched through tertiary sources of information specifically looking for systematic reviews and recommendations made by internationally referenced technology evaluating institutes.
Results: Four random clinical trials (RCT) were found controlled with placebo, neither of them found any significant differences for their primary end point: mayor cardiac event, death, fatal acute myocardial infarction, fatal stroke or other cause of cardiovascular death. None of the RCT used the statin at a loading dose or within the first 24 h from the onset of symptoms.
Conclusion: Due to the lack of evidence that would let us project with clarity a beneficial role for therapy with statins in the initial management of acute coronary syndrome, it's considered that the risk/benefit ratio moves away from the rational use of medicines and the application of the Evidence Based Medicine paradigm.