Rebound inflammatory response during the acute phase of myocardial infarction after simvastatin withdrawal

• Published in: Atherosclerosis 2009-11, Vol.207 (1), p.191-194
• Main Authors: Sposito, Andrei C, Carvalho, Luiz Sergio F, Cintra, Riobaldo M.R, Araújo, Ana Laura R, Ono, Andre H, Andrade, Joalbo M, Coelho, Otavio Rizzi, Quinaglia e Silva, Jose C
• Format: Article
• Language: English
• Subjects: Aged; Anti-Inflammatory Agents - administration & dosage; Atherosclerosis (general aspects, experimental research); Biological and medical sciences; Biomarkers - blood; Blood and lymphatic vessels; C-Reactive Protein - metabolism; Cardiology. Vascular system; Cardiovascular; Coronary heart disease; Drug Administration Schedule; Female; Heart; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors - administration & dosage; Inflammation; Inflammation - blood; Inflammation - etiology; Lipids - blood; Male; Medical sciences; Middle Aged; Myocardial infarction; Myocardial Infarction - blood; Myocardial Infarction - drug therapy; Prospective Studies; Rebound effect; Simvastatin - administration & dosage; Statins; Time Factors; Up-Regulation
• ISSN: 0021-9150; 1879-1484
• DOI: 10.1016/j.atherosclerosis.2009.04.008

Abstract Objective The present study aimed to verify the existence of a rebound inflammatory effect after statin withdrawal in the acute phase of myocardial infarction (MI). Methods In a prospective observational cohort, changes in C-reactive protein (CRP) between the first and the fifth day after MI were evaluated in 249 consecutive patients who were using statins prior to and during MI (SS), statins prior to but not during MI (SN), no statin prior to but during MI (NS), and no statin prior to nor during MI (NN). Data are presented as median (interquartile range). Results At baseline, statin users presented a trend to lower CRP values as compared with those without this treatment before the MI (NN: 1.0(0.4–1.5) mg/dL vs. NS: 1.0(0.3–2.8) mg/dL vs. SS: 0.5(0.3–1.0) mg/dL vs. SN: 0.6(0.4–1.0) mg/dL; p = 0.08). By the fifth day, median CRP was significantly higher in the SN (18.1(16.1–23.2) mg/dL) group as compared with other groups (NN: 10.5(9.3–13.2) mg/dL vs. NS: 2.9(1.5–4.5) mg/dL vs. SS: 1.1(0.8–2.4) mg/dL; p < 0.0001). At the fifth day, the median CRP in the NN group was lower than in the SN group ( p < 0.0001), but higher than the NS and SS groups ( p < 0.0001). There was no significant correlation between CRP change and the change of LDL-cholesterol, HDL-cholesterol or triglycerides. Conclusion The present study has, for the first time, provided evidence for the existence of a rebound inflammatory effect after statin cessation. This rebound reaction may contribute for the adverse outcome of patients who stop statin treatment during MI.