Mild Heart Attacks Studied

Friday, November 17th 2000, 12:00 am

By: News On 6

NEW ORLEANS (AP) â€” Everyone hospitalized with a mild heart attack or bad chest pain should quickly get a cholesterol-lowering drug and undergo testing for possible angioplasty or bypass surgery, two large studies conclude.

The studies, released Wednesday, could transform treatment for the 1 million to 2 million Americans each year who go to the hospital with small heart attacks or severe angina pain.

One study found that immediately giving them the cholesterol-lowering drug Lipitor â€” regardless of their cholesterol levels â€” could reduce the risk of death, new heart attacks and other bad outcomes by 16 percent.

The other study found that routinely checking these patients' heart arteries with angiograms, then fixing blockages when necessary with bypass surgery or balloon angioplasty, could reduce these events by 18 percent.

Lipitor and other cholesterol-lowering drugs known as statins are already a mainstay of treating people with bad hearts. However, heart attacks can disrupt cholesterol readings, so doctors often wait a few weeks before starting patients on the medicines.

Also, patients who suffer only mild heart attacks or chest pain are not always evaluated for angioplasty or bypass surgery.

Dr. Christopher Cannon of Brigham and Women's Hospital in Boston, who conducted the angiogram research, said he believes the results of both studies should immediately be put into practice.

Other doctors said the results may indeed change medical care, but they cautioned that doctors will need time to sort out the findings. They also noted that many small hospitals cannot perform angiograms.

The results of both studies were released at a meeting in New Orleans of the American Heart Association. The cholesterol-lowering drug study was sponsored by Pfizer, which makes Lipitor, while the angiogram study was financed by Merck, which makes one of the medicines used in the research.

``Patients with a threatened or mild heart attack benefited from immediate and intense treatment'' with Lipitor, said Dr. Gregory Schwartz of the Denver Veterans Affairs Medical Center, who led the study.

The study suggests that fast, across-the-board treatment is important, because patients do better no matter what their cholesterol level. Indeed, the study found just as much benefit among those with low cholesterol as in patients with high readings.

The researchers randomly assigned patients to get either Lipitor or a dummy pill, in addition to all of the usual medicines, within a day or so of entering the hospital. Before treatment, their levels of LDL â€” the bad cholesterol â€” averaged 123. After treatment it fell to 72.

After 16 weeks of follow-up, 15 percent of the patients getting Lipitor had died, suffered a heart attack or cardiac arrest or needed emergency rehospitalization, compared with 17 percent in the comparison group.

``Their approach was to start therapy and ask questions later,'' said Dr. Robert O. Bonow of Northwestern University. ``That might be the right approach. Their data were compelling.''

The findings raise the possibility that the drug has some benefit beyond lowering cholesterol. For instance, it may stabilize the fatty buildups on artery walls that can burst and trigger a heart attack.

Cannon's study involved 2,220 patients who were randomly assigned to get standard care or to receive angiograms and artery-clearly treatments, if necessary, within four to 48 hours after reaching the hospital. They found that over the next six months, 16 percent of those getting the fast angiograms died, suffered heart attacks or were readmitted for bad chest pain. By comparison, 19 percent of those getting standard treatment had these bad outcomes.

Earlier studies of quick angiograms have produced conflicting results. Cannon said this study is the first to use state-of-the-art treatment, including stents to prop open newly reopened arteries and the anti-clotting drug Aggrastat.

However, Dr. Rodman Starke of the American Heart Association cautioned that catheterization labs necessary to do angiograms are not available everywhere.

``A lot of hospitals are not set up to do this,'' he said. ``It would be hard to recommend a blanket change in the way these patients are handled.''

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On the Net:

American Heart Association: http://americanheart.org