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 .
High-dose atorvastatin vs usual-dose simvastatin for secondary prevention after myocardial infarction: the IDEAL study: a randomized controlled trial.
CONTEXT Evidence suggests that more intensive lowering of low-density lipoprotein cholesterol ( LDL-C ) than is commonly applied clinical ly will provide further benefit in stable coronary artery disease . OBJECTIVE To compare the effects of 2 strategies of lipid lowering on the risk of cardiovascular disease among patients with a previous myocardial infa rct ion ( MI ) . DESIGN , SETTING , AND PARTICIPANTS The IDEAL study , a prospect i ve , r and omized , open-label , blinded end-point evaluation trial conducted at 190 ambulatory cardiology care and specialist practice s in northern Europe between March 1999 and March 2005 with a median follow-up of 4.8 years , which enrolled 8888 patients aged 80 years or younger with a history of acute MI . INTERVENTIONS Patients were r and omly assigned to receive a high dose of atorvastatin ( 80 mg/d ; n = 4439 ) , or usual-dose simvastatin ( 20 mg/d ; n = 4449 ) . MAIN OUTCOME MEASURE Occurrence of a major coronary event , defined as coronary death , confirmed nonfatal acute MI , or cardiac arrest with resuscitation . RESULTS During treatment , mean LDL-C levels were 104 ( SE , 0.3 ) mg/dL in the simvastatin group and 81 ( SE , 0.3 ) mg/dL in the atorvastatin group . A major coronary event occurred in 463 simvastatin patients ( 10.4 % ) and in 411 atorvastatin patients ( 9.3 % ) ( hazard ratio [ HR ] , 0.89 ; 95 % CI , 0.78 - 1.01 ; P = .07 ) . Nonfatal acute MI occurred in 321 ( 7.2 % ) and 267 ( 6.0 % ) in the 2 groups ( HR , 0.83 ; 95 % CI , 0.71 - 0.98 ; P = .02 ) , but no differences were seen in the 2 other components of the primary end point . Major cardiovascular events occurred in 608 and 533 in the 2 groups , respectively ( HR , 0.87 ; 95 % CI , 0.77 - 0.98 ; P = .02 ) . Occurrence of any coronary event was reported in 1059 simvastatin and 898 atorvastatin patients ( HR , 0.84 ; 95 % CI , 0.76 - 0.91 ; P<.001 ) . Noncardiovascular death occurred in 156 ( 3.5 % ) and 143 ( 3.2 % ) in the 2 groups ( HR , 0.92 ; 95 % CI , 0.73 - 1.15 ; P = .47 ) . Death from any cause occurred in 374 ( 8.4 % ) in the simvastatin group and 366 ( 8.2 % ) in the atorvastatin group ( HR , 0.98 ; 95 % CI , 0.85 - 1.13 ; P = .81 ) . Patients in the atorvastatin group had higher rates of drug discontinuation due to nonserious adverse events ; transaminase elevation result ed in 43 ( 1.0 % ) vs 5 ( 0.1 % ) withdrawals ( P<.001 ) . Serious myopathy and rhabdomyolysis were rare in both groups . CONCLUSIONS In this study of patients with previous MI , intensive lowering of LDL-C did not result in a significant reduction in the primary outcome of major coronary events , but did reduce the risk of other composite secondary end points and nonfatal acute MI . There were no differences in cardiovascular or all-cause mortality .  Patients with MI may benefit from intensive lowering of LDL-C without an increase in noncardiovascular mortality or other serious adverse reactions . Trial Registration Clinical Trials.gov Identifier : NCT00159835
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 .