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 .
Beneficial effects of pravastatin (+/-colestyramine/niacin) initiated immediately after a coronary event (the randomized Lipid-Coronary Artery Disease [L-CAD] Study).
Secondary prevention of coronary heart disease by antilipidemic therapy beginning at > or =3 months after an acute coronary syndrome is well documented . The impact , however , of immediate initiation of antilipidemic therapy on coronary stenoses and clinical outcome in patients with acute coronary syndrome is unknown . In our study , patients were r and omized , on average , 6 days after an acute myocardial infa rct ion and /or percutaneous transluminal coronary angioplasty secondary to unstable angina , to pravastatin ( combined , when necessary , with cholestyramine and /or nicotinic acid )  to achieve low-density lipoprotein cholesterol levels of < or = 130 mg/dl ( group A , n = 70 ) . In controls ( group B , n = 56 ) , antilipidemic therapy was determined by family physicians  . Quantitative coronary angiography was performed at inclusion , and at 6- and 24-month follow-up . The combined clinical end points were total mortality , cardiovascular death , nonfatal myocardial infa rct ion , need for coronary intervention , stroke , and new onset of peripheral vascular disease . Minimal lumen diameter in group A increased by 0.05 + /- 0.20 mm after 6 months and 0.13 + /- 0.29 mm after 24 months , whereas it decreased by 0.08 + /- 0.20 mm and 0.18 + /- 0.27 mm , respectively , in group B ( p = 0.004 at 6 months and p < 0.001 at 24 months ) . After 2 years , 29 patients of 56 patients in group B , but only 16 of 70 patients in group A , experienced a clinical end point ( p = 0.005 ; odds ratio 0.28 , confidence intervals 0.13 to 0.6 ) . We conclude that pravastatin-based therapy initiated immediately after an acute coronary syndrome is well tolerated and safe , lessens coronary atherosclerosis , and has a pronounced clinical benefit
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 .