SYSTEMATIC REVIEW

Intensive statin therapy in acute coronary syndromes and stable coronary heart disease: a comparative meta-analysis of randomised controlled trials

Jonathan Afilalo¹, Agnieska A Majdan¹, Mark J Eisenberg²

¹ Department of Medicine, Sir Mortimer B Davis Jewish General Hospital, McGill University, Montreal, Quebec, Canada
² Department of Medicine, Divisions of Cardiology and Clinical Epidemiology, Sir Mortimer B Davis Jewish General Hospital, McGill University, Montreal, Quebec, Canada

Correspondence to:
Associate Professor Mark J Eisenberg
3755 Cote Ste Catherine Suite A-118, Montreal, Quebec, Canada H3T 1E2; meisenberg{at}epid.jgh.mcgill.ca

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 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.

Abbreviations: ACS, acute coronary syndromes; CHD, coronary heart disease; CI, confidence interval; CRP, C reactive protein; LDL-C, low density lipoprotein cholesterol; MACE, major adverse cardiovascular events; OR, odds ratio; QUORUM, Quality of Reports of Meta-Analyses; RCT, randomised controlled trial

Keywords: mortality; meta-analysis; lipids; cholesterol; coronary disease

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