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Cochrane corner: early statin therapy in acute coronary syndromes—what is the clinical benefit?
  1. Alain Nordmann1,
  2. Gregory Schwartz2,
  3. Noah Vale3,
  4. Heiner C Bucher1,
  5. Matthias Briel1,4
  1. 1Department of Clinical Research, Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel, Switzerland
  2. 2VA Medical Center and University of Colorado, Denver, Colorado, USA
  3. 3Private Practice in Family Medicine, Toronto, Canada
  4. 4Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada
  1. Correspondence to Dr Matthias Briel, Department of Clinical Research, Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel 4031, Switzerland; Matthias.Briel{at}usb.ch

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The time period shortly after an acute coronary syndrome (ACS) is critical for patients with coronary heart disease. Pathophysiologically, endothelial dysfunction of arteries, platelet aggregability, thrombus formation and vascular inflammation increase the risk for recurrent events and death due to vessel occlusion from vulnerable coronary plaques. Thanks to their pleiotropic effects, statins may improve these unfavourable pathophysiological mechanisms and hereby reduce the risk of further ischaemic cardiovascular events.1

A recent Cochrane systematic review assessed the effects of early administered statins on mortality, cardiovascular morbidity and adverse events such as myopathy of patients with ACS. The review included 18 controlled trials that randomised >14 000 patients to early statin treatment (initiation within 14 days of ACS onset) or placebo/usual care.2 The overall quality of the evidence was moderate because of concerns about risk of bias and imprecision of summary estimates. Early statin therapy did not significantly reduce the risk for the combined primary outcome of death, non-fatal myocardial infarction and stroke at 1 month (risk ratio (RR) 0.93, 95% CI 0.80 to 1.08) nor at 4 months of follow-up …

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