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).

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