Statin treatment in acute coronary syndrome

• there is substantial evidence for the statin treatment in the context of secondary prevention of cardiovascular disease
• however the short-term effects of early treatment with statins in patients after the onset of acute coronary syndromes (ACS) for the outcomes of death, myocardial infarction (MI), and stroke are unclear (1)
  • a meta-analysis involving 13 024 patients with acute coronary syndrome (ACS) was undertaken (1)
    • risk ratios for the combined end point of death, MI, and stroke for patients treated with early statin therapy compared with control therapy were 0.93 (95% confidence interval [CI], 0.80-1.09; P = .39) at 1 month and 0.93 (95% CI, 0.81-1.07; P = .30) at 4 months following ACS
    • there were no statistically significant risk reductions from statins for total death, total MI, total stroke, cardiovascular death, fatal or nonfatal MI, or revascularization procedures (percutaneous coronary intervention or coronary artery bypass graft surgery)
    • sensitivity analyses with restriction to trials of high quality or with additional data from a large trial using cerivastatin indicated summary risk ratios even closer to 1.
      • the study authors concluded, based on available evidence, initiation of statin therapy within 14 days following onset of ACS does not reduce death, MI, or stroke up to 4 months
  • a futher meta-analysis has also been undertaken examining the benefits of early statin therapy in ACS (2)
    • thirteen randomized controlled trials published before May 2006 were available, involving 17 963 adults (median number of patients, 135; median follow-up, 6 months)
    • survival curves revealed that this benefit begins to occur between 4 and 12 months, achieving statistical significance by 12 months
    • the authors concluded that early, intensive statin therapy reduces death and cardiovascular events after 4 months of treatment

Reference:

1. Briel M et al.Effects of early treatment with statins on short-term clinical outcomes in acute coronary syndromes: a meta-analysis of randomized controlled trials. JAMA. 2006 May 3;295(17):2046-56.
2. Hulten E et al. The effect of early, intensive statin therapy on acute coronary syndrome: a meta-analysis of randomized controlled trials. Arch Intern Med. 2006 Sep 25;166(17):1814-21