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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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Slawson, David C., et al., editors. "Intensive Lipid Lowering Reduces Mortality Following ACS." EE+ POEM Archive, John Wiley & Sons, 2019. Evidence Central, evidence.unboundmedicine.com/evidence/view/infoPOEMs/426559/all/Intensive_lipid_lowering_reduces_mortality_following_ACS.
Intensive lipid lowering reduces mortality following ACS. In: Slawson DC, Shaughnessy AF, Ebell MH, et al, eds. EE+ POEM Archive. John Wiley & Sons; 2019. https://evidence.unboundmedicine.com/evidence/view/infoPOEMs/426559/all/Intensive_lipid_lowering_reduces_mortality_following_ACS. Accessed July 17, 2019.
Intensive lipid lowering reduces mortality following ACS. (2019). In Slawson, D. C., Shaughnessy, A. F., Ebell, M. H., & Barry, H. (Eds.), EE+ POEM Archive. Available from https://evidence.unboundmedicine.com/evidence/view/infoPOEMs/426559/all/Intensive_lipid_lowering_reduces_mortality_following_ACS
Intensive Lipid Lowering Reduces Mortality Following ACS [Internet]. In: Slawson DC, Shaughnessy AF, Ebell MH, Barry H, editors. EE+ POEM Archive. John Wiley & Sons; 2019. [cited 2019 July 17]. Available from: https://evidence.unboundmedicine.com/evidence/view/infoPOEMs/426559/all/Intensive_lipid_lowering_reduces_mortality_following_ACS.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Intensive lipid lowering reduces mortality following ACS ID - 426559 ED - Slawson,David C, ED - Shaughnessy,Allen F, ED - Ebell,Mark H, ED - Barry,Henry, BT - EE+ POEM Archive UR - https://evidence.unboundmedicine.com/evidence/view/infoPOEMs/426559/all/Intensive_lipid_lowering_reduces_mortality_following_ACS PB - John Wiley & Sons DB - Evidence Central DP - Unbound Medicine ER -