Based on moderate quality evidence , due to concerns about risk of bias and imprecision , initiation of statin therapy within 14 days following ACS does not reduce death , myocardial infa rct ion , or stroke up to four months , but reduces the occurrence of unstable angina at four months following ACS .
Serious side effects were rare
BACKGROUND The early period following the onset of acute coronary syndrome ( ACS ) represents a critical stage of coronary heart disease , with a high risk of recurrent events and deaths .
The short-term effects of early treatment with statins on patient-relevant outcomes in patients suffering from ACS are unclear .
This is an up date of a review previously published in 2011 .
OBJECTIVES To assess the effects , both harms and benefits , of early administered statins in patients with ACS , in terms of mortality and cardiovascular events .
Benefits of early lipid-lowering intervention in high-risk patients: the lipid intervention strategies for coronary patients study.
BACKGROUND There is controversy about whether lipid-lowering pharmacotherapy should be initiated immediately after an acute coronary event or only after diet and lifestyle changes have proved inadequate . OBJECTIVE This study , known as the Lipid Intervention Strategies for Coronary Patients Study , compared the efficacy of immediate versus deferred simvastatin treatment in conjunction with dietary advice about reducing lipid levels in hypercholesterolemic patients with acute coronary syndromes . METHODS This r and omized , open-label , parallel-group study included 151 hypercholesterolemic ( low-density lipoprotein cholesterol [ LDL-C ] > 3.0 mmol/L ) men and women aged 35 to 75 years . Within 4 days of diagnosis of acute myocardial infa rct ion ( MI ) or unstable angina pectoris , all patients received dietary advice from a specially trained nurse . Subsequently , patients were r and omized to 2 treatment groups : 1 group received immediate treatment with simvastatin 40 mg/d ; patients in the other group received simvastatin 40 mg/d after 3 months only if their LDL-C remained > 3.0 mmol/L. RESULTS The immediate-simvastatin group ( n = 73 ) and the deferred-simvastatin group ( n = 78 ) were balanced with respect to baseline characteristics . Of the 151 patients , 25 % were women , 25 % had concomitant hypertension , and 75 % had a diagnosis of MI on enrollment . At 3 months , 90 % of the patients receiving dietary advice plus immediate simvastatin treatment had achieved the recommended European target LDL-C level of < 3.0 mmol/L , compared with 7 % of those treated with diet alone . By 6 months , when 92 % of the study participants were receiving simvastatin 40 mg/d , the proportion of patients achieving target LDL-C levels was 92 % in the group that received immediate simvastatin therapy and 81 % in the group that received deferred simvastatin therapy . The reductions in LDL-C ( 42%-48 % ) were considered to be clinical ly comparable between the 2 groups at 12 months . CONCLUSIONS On the basis of these results , we concluded that few patients with hypercholesterolemia and acute coronary syndromes reach the recommended European target LDL-C level of < 3.0 mmol/L with dietary advice alone . However , early treatment with simvastatin 40 mg/d combined with dietary advice and follow-up at a dedicated outpatient clinic specializing in coronary heart disease result ed in 9 out of 10 patients reaching a recommended target LDL-C level of < 3.0 mmol/L. Initiation of simvastatin therapy while a patient is hospitalized may increase the likelihood of the patient 's lipid levels being managed according to current recommendations after he or she is discharged
Based on moderate quality evidence , due to concerns about risk of bias and imprecision , initiation of statin therapy within 14 days following ACS does not reduce death , myocardial infa rct ion , or stroke up to four months , but reduces the occurrence of unstable angina at four months following ACS .
Serious side effects were rare
BACKGROUND The early period following the onset of acute coronary syndrome ( ACS ) represents a critical stage of coronary heart disease , with a high risk of recurrent events and deaths .
The short-term effects of early treatment with statins on patient-relevant outcomes in patients suffering from ACS are unclear .
This is an up date of a review previously published in 2011 .
OBJECTIVES To assess the effects , both harms and benefits , of early administered statins in patients with ACS , in terms of mortality and cardiovascular events .