Lee CH et al. (2004) Beneficial effects of fluvastatin following percutaneous coronary intervention in patients with unstable and stable angina: results from the Lescol intervention prevention study (LIPS). Heart 90: 1156–1161

Patients undergoing percutaneous coronary intervention (PCI) remain susceptible to major adverse cardiac events (MACE) after revascularization. Lipid-lowering treatment with statins has been shown to reduce this risk. The Lescol intervention prevention study (LIPS) showed a reduced risk of MACE in patients with average cholesterol levels who were treated with fluvastatin at hospital discharge, after a first PCI. Since little is known about the potential benefits of statins in patients with unstable angina, Lee et al. have carried out a subgroup analysis, comparing outcomes in patients with unstable angina (n = 824) or stable angina (n = 834).

Following PCI, approximately half of the patients in each group were randomized to fluvastatin 40 mg twice daily, and the remainder received placebo. During a median follow-up of 3.9 years, there was a similar incidence of MACE in both angina groups. Compared with placebo, treatment with fluvastatin was associated with a significant reduction in the risk of MACE in patients with unstable angina (relative risk 0.72, 95% CI 0.47 to 0.90; P = 0.03). A treatment-status interaction analysis revealed that outcomes were similar in the stable angina group. Cholesterol lowering with fluvastatin was comparable in patients with unstable or stable angina.

The authors conclude that long-term treatment with fluvastatin was beneficial in all patients, irrespective of anginal status. They recommend that lipid-lowering treatment should be started at hospital discharge in all patients undergoing PCI.