The effect of early, intensive statin therapy on acute coronary syndrome: a meta-analysis of randomized controlled trials. Arch Intern Med 2006 Sep 25;166(17):1814-21
Date
09/27/2006Pubmed ID
17000936DOI
10.1001/archinte.166.17.1814Scopus ID
2-s2.0-33749002873 (requires institutional sign-in at Scopus site) 183 CitationsAbstract
BACKGROUND: In addition to well-established secondary prevention benefits for atherosclerotic coronary artery disease, 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors (statins) are hypothesized to have short-term benefit in acute coronary syndrome (ACS), yet the data are inconsistent, with some trials underpowered to demonstrate therapeutic benefit. Our objective was to determine the effects of early, intensive statin therapy for ACS.
DATA SOURCES: Studies found in the PubMed, MEDLINE, EMBASE, BIOSIS, SciSearch, PASCAL, and International Pharmaceutical Abstracts (IPA) databases and the Cochrane Controlled Trials Register published between January 1974 and May 2006.
STUDY SELECTION: Randomized controlled trials of statins begun within 14 days of hospitalization for ACS were included.
DATA EXTRACTION: Two investigators independently abstracted study quality, characteristics, and outcomes.
DATA SYNTHESIS: Thirteen randomized controlled trials published before May 2006 were available, involving 17 963 adults (median number of patients, 135; median follow-up, 6 months). Early, intensive statin therapy for ACS decreased the rate of death and cardiovascular events over 2 years of follow-up (hazard ratio, 0.81 [95% confidence interval, 0.77-0.87]) (Q(3) = 58.54; P<.001; I(2) = 95%). Survival curves revealed that this benefit begins to occur between 4 and 12 months, achieving statistical significance by 12 months. There was no evidence of publication bias, and sensitivity analyses did not identify a dominating study or study characteristic.
CONCLUSIONS: Early, intensive statin therapy reduces death and cardiovascular events after 4 months of treatment. The validity of this finding would be strengthened by an analysis of individual patient data.
Author List
Hulten E, Jackson JL, Douglas K, George S, Villines TCAuthor
Jeffrey L. Jackson MD Professor in the Medicine department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
HumansHydroxymethylglutaryl-CoA Reductase Inhibitors
Myocardial Ischemia
Randomized Controlled Trials as Topic
