The effect of early, intensive statin therapy on acute coronary syndrome: a meta-analysis of randomized controlled trials.
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.
Hulten
Eddie
E
Department of Internal Medicine, General Internal Medicine, and Cardiology, Walter Reed Army Medical Center, Washington, DC, USA. edward.hulten@us.army.mil
Jackson
Jeffrey L
JL
Douglas
Kevin
K
George
Susan
S
Villines
Todd C
TC
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
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors