Effects of aggressive therapy with simvastatin in patients with acute coronary syndrome and initially normal level of LDLP cholesterol on cardiovascular outcomes (LAOKOON). Pilot randomized trial

AIM: To examine anti-inflammatory effect of statins on outcomes of acute coronary syndrome (ACS). MATERIAL AND METHODS: The trial included 211 ACS patients without ST elevation at ECG. The patients were followed up for 180 days. The anti-inflammatory action was studied for 30 days. The patients were divided into two groups by the treatment: simvastatin 10 mg + aspirin 325 mg (104 patients, group 1) and simvastatin 40 mg + aspirin 325 mg (107 patients, group 2) for 30 days. RESULTS: Simvastatin in maximal dose lowed LDLP cholesterol from 101 +/- 9.8 to 72 +/- 3.3 mg/dl, in a minimal dose--from 104 +/- 11.3 to 81 +/- 2.1 mg/dl (p < 0.05). Only maximal dose simvastatin produced a significant reduction of C-reactive protein (CRP) to the disease day 14. The integral index including all cases of cardiovascular death +acute myocardial infarction+progressive angina+rehospitalization was 70 scores for group 1 and 137 for group 2 (p = 0.047). CONCLUSION: Use of simvastatin in ACS patients, initially normal level of LDLP cholesterol and elevated level of CRP produced a dose-dependent effect, alleviated inflammation and improved the disease course.