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International Center for Circulatory Health, Imperial College London, London, United Kingdom. p.sever@imperial.ac.uk The lipid-lowering properties of statins reduce rates of coronary artery disease (CAD) events and strokes. Findings of recently conducted, longitudinal intervention studies suggest that these benefits occur early and may be, in part, independent of the lipid-lowering properties of statin therapy. We analyzed data from the Anglo-Scandinavian Cardiac Outcomes Trial-Lipid-Lowering Arm (ASCOT-LLA) to determine the timing of cardiovascular risk reduction. Relative risk reductions in CAD events were large compared with placebo, becoming apparent at 30 days and significant within 3 months, but they tended to decrease with time. Risk reductions in stroke were also apparent at 30 days but remained constant throughout the trial. Significant differences in hazard ratio between atorvastatin and placebo occurred at 2-year follow-up. Such apparently differential effects on CAD and stroke events suggest that mechanisms of action for CAD and stroke prevention may be different. These observations support the hypothesis that non-lipid-lowering actions of atorvastatin may have contributed to early protection against CAD in ASCOT-LLA.

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