title: The effect of early, intensive statin therapy on acute coronary syndrome: a meta-analysis of randomized controlled trials.
abstract: 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.
  
  
  METHODS
  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.
  
  
  METHODS
  Randomized controlled trials of statins begun within 14 days of hospitalization for ACS were included.
  
  
  METHODS
  Two investigators independently abstracted study quality, characteristics, and outcomes.
  
  
  RESULTS
  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.
authors.affiliation: Department of Internal Medicine, General Internal Medicine, and Cardiology, Walter Reed Army Medical Center, Washington, DC, USA. edward.hulten@us.army.mil
authors.forename: Eddie
authors.initials: E
authors.lastname: Hulten
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Jackson
authors.forename: Kevin
authors.initials: K
authors.lastname: Douglas
authors.forename: Susan
authors.initials: S
authors.lastname: George
authors.forename: Todd C
authors.initials: TC
authors.lastname: Villines
mesh_terms: D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D017202:Myocardial Ischemia / Q000188:drug therapy* / Q000401:mortality; D016032:Randomized Controlled Trials as Topic
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors