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 .
Intensive versus moderate lipid lowering with statins after acute coronary syndromes.
BACKGROUND Lipid-lowering therapy with statins reduces the risk of cardiovascular events , but the optimal level of low-density lipoprotein ( LDL ) cholesterol is unclear . METHODS We enrolled 4162 patients who had been hospitalized for an acute coronary syndrome within the preceding 10 days and compared 40  mg of pravastatin daily ( st and ard therapy ) with 80 mg of atorvastatin daily ( intensive therapy ) . The primary end point was a composite of death from any cause , myocardial infa rct ion , documented unstable angina requiring rehospitalization , revascularization ( performed at least 30 days after r and omization ) , and stroke . The study was design ed to establish the noninferiority of pravastatin as compared with atorvastatin with respect to the time to an end-point event . Follow-up lasted 18 to 36 months ( mean , 24 ) . RESULTS The median LDL cholesterol level achieved during treatment was 95 mg per deciliter ( 2.46 mmol per liter ) in the st and ard-dose pravastatin group and 62 mg per deciliter ( 1.60 mmol per liter ) in the high-dose atorvastatin group ( P<0.001 ) . Kaplan-Meier estimates of the rates of the primary end point at two years were 26.3 percent in the pravastatin group and 22.4 percent in the atorvastatin group , reflecting a 16 percent reduction in the hazard ratio in favor of atorvastatin ( P=0.005 ; 95 percent confidence interval , 5 to 26 percent ) . The study did not meet the prespecified criterion for equivalence but did identify the superiority of the more intensive regimen . CONCLUSIONS Among patients who have recently had an acute coronary syndrome , an intensive lipid-lowering statin regimen provides greater protection against death or major cardiovascular events than does a st and ard regimen . These findings indicate that such patients benefit from early and continued lowering of LDL cholesterol to levels substantially below current target levels
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 .