BACKGROUND: Intensive statin therapy reduces major adverse cardiovascular events (MACE), but the effect on mortality is unclear. OBJECTIVE: To determine whether intensive statin therapy reduces all-cause mortality compared with moderate statin therapy in patients with recent acute coronary syndromes (ACS) and stable coronary heart disease (CHD). METHODS: Medline, Embase, the Cochrane Database, the internet, and conference proceedings from 1966 to 2006 were searched to identify relevant trials. Selection criteria were randomised allocation to intensive statin therapy (atorvastatin 80 mg/day, simvastatin 80 mg/day, or rosuvastatin 20-40 mg/day) versus moderate statin therapy, recent ACS or stable CHD at the time of randomisation, and > or =6 months of follow-up. RESULTS: Six trials, encompassing 110 271 patient-years, were pooled. In patients with recent ACS, intensive statin therapy reduced all-cause mortality from 4.6% to 3.5% over 2.0 years (OR = 0.75, 95% CI 0.61 to 0.93). In patients with stable CHD, intensive statin therapy had no effect on all-cause mortality over 4.7 years (OR = 0.99, 95% CI 0.89 to 1.11). Overall, intensive statin therapy was associated with a reduction in MACE (OR = 0.84, 95% CI 0.77 to 0.91) and admissions to hospital for heart failure (OR = 0.72, 95% CI 0.62 to 0.83). Intensive statin therapy was also associated with an increase in hepatic transaminases >3 times normal (OR = 3.73, 95% CI 2.11 to 6.58) and a trend towards increased creatine kinase >10 times normal and/or rhabdomyolysis (OR = 1.96, 95% CI 0.50 to 7.63). CONCLUSIONS: Compared with moderate statin therapy, intensive statin therapy reduces all-cause mortality in patients with recent ACS but not in patients with stable CHD.
BACKGROUND: Intensive statin therapy reduces major adverse cardiovascular events (MACE), but the effect on mortality is unclear. OBJECTIVE: To determine whether intensive statin therapy reduces all-cause mortality compared with moderate statin therapy in patients with recent acute coronary syndromes (ACS) and stable coronary heart disease (CHD). METHODS: Medline, Embase, the Cochrane Database, the internet, and conference proceedings from 1966 to 2006 were searched to identify relevant trials. Selection criteria were randomised allocation to intensive statin therapy (atorvastatin 80 mg/day, simvastatin 80 mg/day, or rosuvastatin 20-40 mg/day) versus moderate statin therapy, recent ACS or stable CHD at the time of randomisation, and > or =6 months of follow-up. RESULTS: Six trials, encompassing 110 271 patient-years, were pooled. In patients with recent ACS, intensive statin therapy reduced all-cause mortality from 4.6% to 3.5% over 2.0 years (OR = 0.75, 95% CI 0.61 to 0.93). In patients with stable CHD, intensive statin therapy had no effect on all-cause mortality over 4.7 years (OR = 0.99, 95% CI 0.89 to 1.11). Overall, intensive statin therapy was associated with a reduction in MACE (OR = 0.84, 95% CI 0.77 to 0.91) and admissions to hospital for heart failure (OR = 0.72, 95% CI 0.62 to 0.83). Intensive statin therapy was also associated with an increase in hepatic transaminases >3 times normal (OR = 3.73, 95% CI 2.11 to 6.58) and a trend towards increased creatine kinase >10 times normal and/or rhabdomyolysis (OR = 1.96, 95% CI 0.50 to 7.63). CONCLUSIONS: Compared with moderate statin therapy, intensive statin therapy reduces all-cause mortality in patients with recent ACS but not in patients with stable CHD.
Authors: Scott Kinlay; Gregory G Schwartz; Anders G Olsson; Nader Rifai; Sally J Leslie; William J Sasiela; Michael Szarek; Peter Libby; Peter Ganz Journal: Circulation Date: 2003-09-15 Impact factor: 29.690
Authors: Christopher P Cannon; Eugene Braunwald; Carolyn H McCabe; Daniel J Rader; Jean L Rouleau; Rene Belder; Steven V Joyal; Karen A Hill; Marc A Pfeffer; Allan M Skene Journal: N Engl J Med Date: 2004-03-08 Impact factor: 91.245
Authors: Steven E Nissen; E Murat Tuzcu; Paul Schoenhagen; B Greg Brown; Peter Ganz; Robert A Vogel; Tim Crowe; Gail Howard; Christopher J Cooper; Bruce Brodie; Cindy L Grines; Anthony N DeMaria Journal: JAMA Date: 2004-03-03 Impact factor: 56.272
Authors: Stefan K James; Paul Armstrong; Elliott Barnathan; Robert Califf; Bertil Lindahl; Agneta Siegbahn; Maarten L Simoons; Eric J Topol; Per Venge; Lars Wallentin Journal: J Am Coll Cardiol Date: 2003-03-19 Impact factor: 24.094
Authors: Ashley J Beard; Timothy P Hofer; John R Downs; Michelle Lucatorto; Mandi L Klamerus; Rob Holleman; Eve A Kerr Journal: Circ Cardiovasc Qual Outcomes Date: 2012-12-11