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Long-Term Benefit of Statin Therapy Initiated during Hospitalization for an Acute Coronary Syndrome

A Systematic Review of Randomized Trials

Abstract

Objective

This study sought to determine if the initiation of statin (HMG-CoA reductase inhibitor) therapy during acute coronary syndromes reduces long-term mortality and other adverse cardiac outcomes.

Background

Initiation of statin therapy during acute coronary syndromes has not been shown to reduce mortality, myocardial infarction or stroke within 4 months of follow-up.

Methods

Clinical trials that randomized patients with acute coronary syndromes to early statin therapy compared with less intensive lipid reduction (placebo/lower-dose statin/usual care), and reported long-term outcomes were included for analysis.

Results

In all, there were seven studies (L-CAD, PTT, FLORIDA, Colivicchi et al., PROVE-IT, ESTABLISH, and A-to-Z) with 9553 patients who started statin therapy within 12 days of hospital presentation. The incidence of all-cause mortality was 3.4% in the statin group versus 4.6% in the less intensive lipid reduction group over a weighted mean follow-up of 22.9 months (relative risk [RR] 0.74; 95% CI 0.61, 0.90; p = 0.003). The number of patients needed to treat to prevent one death was 84 patients. Similarly, the incidence of cardiovascular mortality in the statin versus the less intensive lipid reduction group was 2.4% versus 3.3% (RR 0.74; 95% CI 0.58, 0.93; p = 0.010), unstable angina 4.1% versus 5.0% (RR 0.81; 95% CI 0.68, 0.98; p = 0.027), revascularization 11.2% versus 12.9% (RR 0.86; 95% CI 0.78, 0.96; p = 0.006), stroke 1.1% versus 1.2% (RR 0.90; 95% CI 0.62, 1.30; p = 0.56), and myocardial infarction 6.6% versus 7.0% (RR 0.94; 95% CI 0.81, 1.09; p = 0.41).

Conclusions

The benefit of early initiation of statin therapy during acute coronary syndromes slowly accrues over time so that a survival advantage is seen around 24 months. Relatively few patients need to be treated to prevent one death over this time period. Furthermore, this approach significantly reduces unstable angina and the need for revascularization.

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Acknowledgments

No sources of funding were used in conducting this research

Dr Bavry discloses the following relationship: Honoraria — Genesis. Dr Askari discloses the following relationship: Speakers bureau — Pfizer. Dr Bhatt discloses the following relationships: Speakers bureau — Bristol Myers Squibb, Sanofi Aventis, The Medicines Company. Honoraria — Astra Zeneca, Bristol Myers Squibb, Eisai, Eli Lilly, Glaxo Smith Kline, Millennium, Paringenix, PDL, Sanofi Aventis, Schering Plough, The Medicines Company. Consultant/Advisory Board — Astra Zeneca, Bristol Myers Squibb, Eisai, Eli Lilly, Glaxo Smith Kline, Millennium, Paringenix, PDL, Sanofi Aventis, Schering Plough, The Medicines Company. Dr Mood, Dr Kumbhani, and Dr Borek have no potential conflicts of interest that are directly relevant to the contents of this manuscript.

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Correspondence to Dr Deepak L. Bhatt.

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Bavry, A.A., Mood, G.R., Kumbhani, D.J. et al. Long-Term Benefit of Statin Therapy Initiated during Hospitalization for an Acute Coronary Syndrome. Am J Cardiovasc Drugs 7, 135–141 (2007). https://doi.org/10.2165/00129784-200707020-00005

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Keywords

  • Statin
  • Acute Coronary Syndrome
  • Pravastatin
  • Statin Therapy
  • Ezetimibe