Statins show potent anti-ischemic effect in stable angina

[Pyankov Vasily]

MedWire News: Statins could exert anti-ischemic effects in patients with chronic stable angina that are as potent as those of the calcium-channel blocker amlodipine, trial findings suggest.

Atorvastatin virtually eliminated episodes of transient myocardial ischemia (TMI) from the daily life of participants in the Double-blind Atorvastatin and Amlodipine (DUAAL) trial.

Interestingly, TMI changes did not appear to relate to the degree by which low-density lipoprotein (LDL) cholesterol was lowered, although the trial was not specifically designed to assess this.

DUAAL investigated the effect of atorvastatin alone and in combination with amlodipine in 311 patients with stable angina and coronary artery disease who had at least three TMI episodes or 15 minutes of ischemia on 48-hour ambulatory electrocardiographic (ECG) monitoring.

Participants were randomly assigned to receive 24 weeks of 5 mg amlodipine once daily rising to 10 mg at 6 weeks, 10 mg of atorvastatin rising to 80 mg or amlodipine plus atorvastatin increased to the same schedule.

The primary efficacy endpoint was the number of ischemic episodes during 48-hour ambulatory ECG monitoring at week 26, with TMI determined from ST-segment depression.

There was a comparable, highly significant decrease in TMI with amlodipine and atorvastatin but no additional benefit with dual therapy, the researchers report in the European Heart Journal.

The median number of TMI episodes per week dropped from 5 in each group to 0.5 with amlodipine, 0 with atorvastatin, and 1 with atorvastatin plus amlodipine.

More than half the patients in all groups became TMI-free and this was accompanied by a comparable, marked reduction in angina and nitroglycerin consumption determined from patient diaries.

High-sensitivity C-reactive protein fell by 40% in patients receiving atorvastatin but there was no change with amlodipine, note John Deanfield (University College London, UK) and colleagues.

This difference, they say, suggests “that the anti-ischemic effects were not achieved by the same mechanisms.”

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Eur Heart J 2010; Advance online publication