Early, Aggressive Statin Therapy in Acute Coronary Syndromes Improves Outcome

Martha Kerr

March 17, 2006

March 17, 2006 (Atlanta) — A meta-analysis of 8 large randomized studies of statin therapy show that initiating statin therapy during the acute phase of an ischemic event reduces mortality, reinfarction, and revascularization. The findings from the meta-analysis were announced at the American College of Cardiology 55th Annual Scientific Session, held here this week.

Presented by Anthony A. Bavry, MD, MPH, fellow in the Department of Medicine at the Cleveland Clinic Foundation in Ohio, the meta-analysis included 15,995 acute coronary syndrome patients who were randomized to receive either aggressive statin therapy (n = 8037) or conservative therapy, consisting of a standard-dose statin or placebo (n = 7958) during the index hospitalization. Statin initiation ranged between 6 hours to 10 days from hospitalization; weighted mean follow-up was 15 months.

Dr. Bavry reported that the incidence of all-cause mortality was 3.1% with aggressive therapy and 4.0% in conservatively managed patients, which accounted for a 25% risk reduction in favor of aggressive therapy. In addition, aggressive therapy reduced the risk of cardiovascular mortality by 22% relative to standard therapy. Although, there was no significant difference in the rates of MI recurrence between the aggressive and standard treatment groups (5.9% vs 6.2%, respectively), there was a slight trend toward a reduced incidence of stroke in the aggressive therapy group (0.91% vs 1.2%). In addition, the incidence of unstable angina and the rates of revascularization were both significantly reduced with aggressive therapy.

Commenting on the implications of the rates of all-cause mortality, Dr. Bavry noted that "it would only take 111 patients treated to save a life. That suggests that early, aggressive treatment is a powerful, powerful treatment." When considering the rates of revascularization and reinfarction, Dr. Bavry added that only approximately 80 patients would need to be treated to prevent 1 event. He concluded that these relatively low numbers of patients needed to treat to prevent death or an adverse event suggests that "this is a pretty simple therapy to save lives."

In an interview with Medscape, Robert A. Harrington, MD, director of cardiovascular clinical trials at Duke University School of Medicine in Durham, North Carolina, said that "the data are remarkably consistent, with a decrease in death, reinfarction, and stroke with early, highly intensive lipid-lowering to below 70 mg/dL."

Dr. Harrington continued, "The question remains, how low do you go? At Duke, we are initiating a trial of lipid-lowering below 50 mg/dL.... My guess is you want to go lower."

Pamela S. Douglas, MD, director of the Department of Cardiology at Duke and president of the American College of Cardiology, commented that the findings show that early, aggressive lipid-lowering is effective in unstable coronary syndromes. She added that "it may be that patients with stable coronary disease might also benefit from aggressive lipid-lowering."

ACC 55th Annual Scientific Session: Abstract 821-5. Presented March 13, 2006.

Reviewed by Ariana Del Negro

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