Intensive lipid lowering reduces mortality following ACS

Clinical Question

Does intensive statin therapy reduce mortality in patients with acute coronary syndrome?

Bottom Line

Intensive statin therapy following acute coronary syndrome (ACS) reduces cardiovascular and overall mortality. (LOE = 1a)


Murphy SA, Cannon CP, Wiviott SD, et al. Effect of intensive lipid-lowering therapy on mortality after acute coronary syndrome (a patient-level analysis of the Aggrastat to Zocor and Pravastatin or Atorvastatin Evaluation and Infection Therapy-Thrombolysis in Myocardial Infarction 22 trials). Am J Cardiol 2007;100(7):1047-1051.  [PMID:17884359]

Study Design

Meta-analysis (randomized controlled trials)




Inpatient (any location) with outpatient follow-up


This study pooled results from 2 randomized trials of intensive lipid lowering versus moderate lipid lowering following ACS to attain a large enough sample to detect a mortality difference. The PROVE-IT-TIMI 22 trial enrolled patients within 10 days of ACS and randomized them to receive either atorvastatin 80 mg or pravastatin 40 mg. The A to Z trial enrolled patients within 5 days of ACS and compared simvastatin 40 mg for 1 month followed by simvastatin 80 mg with placebo for 4 months followed by simvastatin 20 mg. Mortality rates for this evaluation were calculated by pooled patient-level data. The 2 trials provided data from a total of 8658 patients. At 4 months and 8 months, the reduction in low-density lipoprotein levels was greatest in the intensive statin group. At 2 years, all-cause mortality was reduced in the intensive statin group compared with the moderate statin group [number needed to treat (NNT) = 77; 95% CI, 46 - 225]. This result was primarily due to a reduction in cardiovascular deaths, which were significantly reduced with intensive therapy (NNT = 112; 61 - 595).