Benefits of early lipid-lowering intervention in high-risk patients: The lipid intervention strategies for coronary patients study

Background: There is controversy about whether lipid-lowering pharmacothera py should be initiated immediately after an acute coronary event or only af ter diet and lifestyle changes have proved inadequate. Objective: This study, known as the Lipid Intervention Strategies for Coron ary Patients Study, compared the efficacy of immediate versus deferred simv astatin treatment in conjunction with dietary advice about reducing lipid l evels in hypercholesterolemic patients with acute coronary syndromes. Methods: This randomized, open-label, parallel-group study included 151 hyp ercholesterolemic (low-density lipoprotein cholesterol [LDL-C] >3.0 mmol/L) men and women aged 35 to 75 years. Within 4 days of diagnosis of acute myo cardial infarction (MI) or unstable angina pectoris, all patients received dietary advice from a specially trained nurse. Subsequently, patients were randomized to 2 treatment groups: 1 group received immediate treatment with simvastatin 40 mg/d; patients in the other group received simvastatin 40 m g/d after 3 months only if their LDL-C remained >3.0 mmol/L. Results: The immediate-simvastatin group (n = 73) and the deferred-simvasta tin group (n = 78) were balanced with respect to baseline characteristics. Of the 151 patients, 25% were women, 25% had concomitant hypertension, and 75% had a diagnosis of MI on enrollment. At 3 months, 90% of the patients r eceiving dietary advice plus immediate simvastatin treatment had achieved t he recommended European target LDL-C level of <3.0 mmol/L, compared with 7% of those treated with diet alone. By 6 months, when 92% of the study parti cipants were receiving simvastatin 40 mg/d, the proportion of patients achi eving target LDL-C levels was 92% in the group that received immediate simv astatin therapy and 81% in the group that received deferred simvastatin the rapy. The reductions in LDL-C (42%-48%) were considered to be clinically co mparable between the 2 groups at 12 months. Conclusions: On the basis of these results, we concluded that few patients with hypercholesterolemia and acute coronary syndromes reach the recommende d European target LDL-C level of <3.0 mmol/L with dietary advice alone. How ever, early treatment with simvastatin 40 mg/d combined with dietary advice and follow-up at a dedicated outpatient clinic specializing in coronary he art disease resulted in 9 out of 10 patients reaching a recommended target LDL-C level of <3.0 mmol/L. Initiation of simvastatin therapy while a patie nt is hospitalized may increase the likelihood of the patient's lipid level s being managed according to current recommendations after he or she is dis charged.