PHARMACOTHERAPY REVIEW CNS STIMULANTS for treatment of ...

MIRACL(Myocardial Ischemia Reduction with Aggressive Cholesterol Lowering Study)• Randomized, double-blind 3086 patients, atorvastatin 80mg/day initiated 24-96 hours afteran acute coronary syndrome (can this reduce the occurrence of early, recurrent ischemicevents and death.)• Primary end point (death, nonfatal acute MI, cardiac arrest with resuscitation, or recurrentsymptomatic myocardial ischemia) 228 patients in the atorvastatin group suffered an eventand 269 in the placebo group.• In conjunction with lowering LDL cholesterol, statins may improve endothelial function,decrease platelet aggregation and thrombus deposits and reduce vascular inflammation.• At week 6 of the 16 weeks of study cholesterol goals had been met in the atorvastatin group.LDL was reduced 40%, Triglycerides reduced 16%, no major change in HDL in either group.• There was no significant difference in risk of death, nonfatal MI, or cardiac arrest withresuscitation between the two groups, although the atorvastatin group had a lower risk ofrecurrent symptomatic myocardial ischemia with objective evidence requiring emergencyrehospitalization.• Moreover, among the atorvastatin-treated patients, there was no significant associationbetween the percent change in LDL cholesterol from baseline to end of the study and theoccurrence of a primary end point event.• Nonetheless, the observation suggests that the decision to initiate intensive lipid-loweringtherapy after ACS should not necessarily be influenced by serum lipid levels at the time ofthe event.• 9 patients in the atorvastatin group suffered nonfatal stroke and 22 patients in the placebogroup.• Abnormal transaminase levels (>3 times ULN) occurred in 38 patients in the atorvastatingroup and 9 in the placebo group.• There were no cases of myositis.• There was a 2.6% absolute reduction and 16% relative reduction in primary end point events.19