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 .
Apolipoprotein E polymorphisms influence effect of pravastatin on survival after myocardial infarction in a Mediterranean population: the GISSI-Prevenzione study.
AIMS Controversy exists with regard to the influence of APOE polymorphisms on coronary heart disease development and on the efficacy of statin treatment . we investigated the relationship between apoe , mortality and the response to treatment in Mediterranean myocardial infa rct ion ( mi ) survivors . METHODS AND RESULTS We analysed 3304 Italian patients with MI r and omized to pravastatin or no treatment in the GISSI-Prevenzione study , with a mean follow-up time of 23.0 + /- 6.7 months ( median 24.3 months ) .  Mortality curves were calculated using Kaplan-Meier method , and differences in survival were tested using the log-rank test . There were 109 deaths during follow-up . Patients treated with pravastatin showed a significant decrease in mortality compared with non-treated patients ( HR 0.67 , 95 % confidence interval 0.45 - 0.97 , P = 0.038 ) . Among the 3304 patients , 554 ( 16.8 % ) were epsilon4 carriers and 2750 ( 83.2 % ) were non-epsilon4 carriers . No significant difference in terms of mortality was observed between the epsilon4 and the non-epsilon4 carriers ( 3.61 % vs. 3.24 % , P = 0.67 ) . However , although in non-epsilon4 carriers no significant difference in mortality was observed between patients treated with pravastatin and non-treated ( 2.81 % vs. 3.67 % , P = 0.21 ) , among the epsilon4 carriers a significant reduction in mortality was observed in patients treated compared with non-treated ( 1.85 % vs. 5.28 % , P = 0.023 ) . CONCLUSION We found that epsilon4 allele is a determinant of pravastatin response in terms of survival . Though in the entire population investigated , we found a beneficial effect of pravastatin in terms of survival , only the epsilon4 carriers seemed to have gained a significant benefit from this treatment . We suggest that the effect of statins is of particular interest in this fraction of the population . Genetic markers can help in identifying patients that benefit more from statin treatment
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 .