title: Statins for acute coronary syndrome.
abstract: BACKGROUND
  The early period following the onset of acute coronary syndromes (ACS) represents a critical stage of coronary heart disease with a high risk for recurrent events and deaths. The short-term effects of early treatment with statins in patients suffering from ACS on patient-relevant outcomes are unclear.
  
  
  OBJECTIVE
  To assess the benefits and harms of early administered statins in patients with ACS from randomized controlled trials (RCTs).
  
  
  METHODS
  We searched CENTRAL, MEDLINE, EMBASE, and CINAHL (to 1 February 2010). No language restrictions were applied. We supplemented the search by contacting experts in the field, by reviewing reference lists of reviews and editorials on the topic, and by searching trial registries.
  
  
  METHODS
  RCTs comparing statins with placebo or usual care, initiation of statin therapy within 14 days following the onset of ACS, and follow-up of at least 30 days reporting at least one clinical outcome.
  
  
  METHODS
  Two authors independently assessed study quality and extracted data. We pooled treatment effects and calculated risk ratios (RRs) for all outcomes in the treatment and control groups using a random effects model.
  
  
  RESULTS
  Eighteen studies (14,303 patients) compared early statin treatment versus placebo or usual care in patients with ACS. Compared to placebo or usual care, early statin therapy did not decrease the combined primary outcome of death, non-fatal myocardial infarction (MI), and stroke at one month (risk ratio (RR) 0.93, 95% confidence interval (CI) 0.80 to 1.08) and four months (RR 0.93, 95% CI 0.81 to 1.06) of follow-up. There were no statistically significant risk reductions from statins for total death, total MI, total stroke, cardiovascular death, revascularization procedures, and acute heart failure at one month and at four months, although there were favorable trends related to statin use for each of these endpoints. The incidence of episodes of unstable angina was significantly reduced at four months following ACS (RR 0.76, 95% CI 0.59 to 0.96). There were nine individuals with myopathy (elevated creatinine kinase levels > 10 times the upper limit of normal) in statin treated patients (0.13%) versus one (0.015%) in the control groups. Serious muscle toxicity was mostly limited to patients treated with simvastatin 80 mg.
  
  
  CONCLUSIONS
  Based on available evidence, initiation of statin therapy within 14 days following ACS does not reduce death, myocardial infarction, or stroke up to four months, but reduces the occurrence of unstable angina at four months following ACS.
authors.affiliation: Family Medicine, St Mary's Hospital, McGill University, 377 Rue Jean Brilliant, Montreal, Quebec, Canada, H3T 1M5.
authors.forename: Noah
authors.initials: N
authors.lastname: Vale
authors.forename: Alain J
authors.initials: AJ
authors.lastname: Nordmann
authors.forename: Gregory G
authors.initials: GG
authors.lastname: Schwartz
authors.forename: James
authors.initials: J
authors.lastname: de Lemos
authors.forename: Furio
authors.initials: F
authors.lastname: Colivicchi
authors.forename: Frank
authors.initials: F
authors.lastname: den Hartog
authors.forename: Petr
authors.initials: P
authors.lastname: Ostadal
authors.forename: Stella M
authors.initials: SM
authors.lastname: Macin
authors.forename: Anho H
authors.initials: AH
authors.lastname: Liem
authors.forename: Edward
authors.initials: E
authors.lastname: Mills
authors.forename: Neera
authors.initials: N
authors.lastname: Bhatnagar
authors.forename: Heiner C
authors.initials: HC
authors.lastname: Bucher
authors.forename: Matthias
authors.initials: M
authors.lastname: Briel
mesh_terms: D054058:Acute Coronary Syndrome / Q000188:drug therapy* / Q000401:mortality; D000789:Angina, Unstable / Q000517:prevention & control; D002318:Cardiovascular Diseases / Q000401:mortality; D002423:Cause of Death; D004334:Drug Administration Schedule; D006333:Heart Failure / Q000517:prevention & control; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D009203:Myocardial Infarction / Q000517:prevention & control; D009204:Myocardial Revascularization / Q000706:statistics & numerical data; D016032:Randomized Controlled Trials as Topic; D020521:Stroke / Q000517:prevention & control
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors