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Intensive statin therapy in acute coronary syndromes and stable coronary heart disease: a comparative meta-analysis of randomised controlled trials
  1. Jonathan Afilalo1,
  2. Agnieska A Majdan1,
  3. Mark J Eisenberg2
  1. 1Department of Medicine, Sir Mortimer B Davis Jewish General Hospital, McGill University, Montreal, Quebec, Canada
  2. 2Department of Medicine, Divisions of Cardiology and Clinical Epidemiology, Sir Mortimer B Davis Jewish General Hospital, McGill University, Montreal, Quebec, Canada
  1. 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

Abstract

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.

  • 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
  • mortality
  • meta-analysis
  • lipids
  • cholesterol
  • coronary disease

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Footnotes

  • Published Online First 3 February 2007

  • J Afilalo participated in the conception and design of the meta-analysis, data acquisition, data analysis and interpretation, drafting of the manuscript, critical review of the manuscript for intellectual content, and statistical analysis. AA Majdan participated in conception and design of the meta-analysis, data acquisition, drafting of the manuscript, and critical review of the manuscript for intellectual content. MJ Eisenberg participated in conception and design of the meta-analysis, data analysis and interpretation, critical review of the manuscript for intellectual content, and administrative support and supervision.Dr Eisenberg is a senior physician scientist of the Quebec Foundation for Health Research. Manuscript presented in abstract form at the World Congress of Cardiology, 6 September 2006.

  • Conflicts of interest: The authors of this meta-analysis have no personal or financial conflicts of interest to report. All authors had full access to all the data and had final responsibility for the decision to submit for publication.

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