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Update in General Internal Medicine
- Catherine Reinis Lucey, MD; and
- Carmella A. Cole, MD
- From Washington Hospital Center, Washington, D.C.
2002–2003 Series: Update Sessions from ACP–ASIM's 2002 Annual Session
David A. Cramer, MD, and Paul T. Kefalides, MD, Co-Editors
This Update in General Internal Medicine examines the topics that we thought were most interesting to the practicing general internist. We address new lessons learned in the previous year about secondary prevention in cardiovascular disease, the management of systolic dysfunction, the specific choice of antihypertensive agents for special populations, the significance of Helicobacter pylori infection, the management of thromboembolic disease, and finally, the use of estrogen replacement therapy.
Secondary Prevention of Cardiovascular Events
Atorvastatin Decreases the Risk for Early Recurrence of Ischemia in Patients Who Have Recently Experienced an Acute Coronary Syndrome
To determine the effectiveness of statin therapy in the acute setting within 24 to 96 hours after an acute coronary syndrome, Schwartz and colleagues conducted a double-blind, placebo-controlled trial of 3086 adults 18 years of age or older with unstable angina or non–Q-wave myocardial infarctions. The patients were randomly assigned to receive atorvastatin, 80 mg/d, or matched placebo beginning between 24 and 96 hours after hospital admission. Patients were excluded if they had had a Q-wave acute myocardial infarction, recent or planned revascularization procedure, severe congestive heart failure, severe hepatic or renal disease, or type 1 diabetes. The primary combined end point was any of the following: death, nonfatal myocardial infarction, cardiac arrest, or recurrent symptomatic objective ischemia at 16 weeks. The analysis was by intention to treat. The mean age of participants was 65 years; 34% of participants were women, 85.5% were white, and 3% were black. The groups were equally matched for cardiovascular disease history, risk factors, baseline lipid measurement, and concurrent therapies.
Patients treated with atorvastatin were less likely than placebo recipients to experience the combined primary end point, mainly because of a lower risk for recurrent, symptomatic, objectively documented ischemia. The solitary end points of death or recurrent myocardial infarction did not differ markedly between groups. The risk for …
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