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BMJ 2006; 332 doi: (Published 11 May 2006) Cite this as: BMJ 2006;332:1146
  1. Alison Tonks (, associate editor

    Early treatment with statins doesn't help patients with acute coronary syndromes

    Statins work well in the long term, reducing serum concentrations of low density lipoprotein cholesterol and protecting patients from heart attacks, strokes, and death. There's some evidence that they also reduce vascular inflammation and stabilise vascular endothelium, although these fast acting physiological effects don't seem to translate into better short term outcomes for patients with acute coronary syndromes.

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    Credit: JAMA

    In a meta-analysis of 12 randomised controlled trials, early treatment with statins did not reduce patients' short term risk of heart attack, stroke, or death compared with a placebo or usual care. The authors found a modest reduction in the risk of unstable angina four months after symptoms had started (206/4268, 4.8% v 256/4238, 6.0%; relative risk 0.80, 95% CI 0.64 to 1.00) but no other clinical benefits.

    The patients were mostly men with a mean age of 55-70 years who had been admitted to hospital with a heart attack or unstable angina. They began treatment 1-10 days after admission, and for this analysis they were followed up for four months.

    Despite these negative findings, it's still a good idea to prescribe statins earlier rather than later, say the authors. It does no harm, benefits will accumulate eventually, and it's likely that starting treatment in hospital improves adherence.

    To prevent stillbirths we must first count them

    Worldwide, more than three million babies are born dead each year, according to recent estimates. Ninety nine per cent are born in developing countries. Half are born in India, China, Pakistan, and Bangladesh, and most of the rest in sub-Saharan Africa. Overall, the rate of stillbirths is five times higher in poor than in rich countries (25.5 v 5.3 per 1000 deliveries).

    Stillbirths are hard to count, particularly in countries with a poor health infrastructure and the highest rates of stillbirth. These researchers used whatever data they could find in birth and …

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