• Online Features  This Article  • Full text  • PDF  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (72)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Topic Collections  • Cardiovascular System  • Quality of Care  • Evidence-Based Medicine  • Review  • Cardiovascular Disease/ Myocardial Infarction  • Alert me on articles by topic  Social Bookmarking   What's this?

A Meta-analysis of Randomized Controlled Trials

Eddie Hulten, MD, MPH; Jeffrey L. Jackson, MD, MPH; Kevin Douglas, MD, MPH; Susan George, MD; Todd C. Villines, MD

Arch Intern Med. 2006;166:1814-1821.

Background  In addition to well-established secondary prevention benefits for atherosclerotic coronary artery disease, 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors (statins) are hypothesized to have short-term benefit in acute coronary syndrome (ACS), yet the data are inconsistent, with some trials underpowered to demonstrate therapeutic benefit. Our objective was to determine the effects of early, intensive statin therapy for ACS.

Data Sources  Studies found in the PubMed, MEDLINE, EMBASE, BIOSIS, SciSearch, PASCAL, and International Pharmaceutical Abstracts (IPA) databases and the Cochrane Controlled Trials Register published between January 1974 and May 2006.

Study Selection  Randomized controlled trials of statins begun within 14 days of hospitalization for ACS were included.

Data Extraction  Two investigators independently abstracted study quality, characteristics, and outcomes.

Data Synthesis  Thirteen randomized controlled trials published before May 2006 were available, involving 17 963 adults (median number of patients, 135; median follow-up, 6 months). Early, intensive statin therapy for ACS decreased the rate of death and cardiovascular events over 2 years of follow-up (hazard ratio, 0.81 [95% confidence interval, 0.77-0.87]) (Q₃ = 58.54; P<.001; I² = 95%). Survival curves revealed that this benefit begins to occur between 4 and 12 months, achieving statistical significance by 12 months. There was no evidence of publication bias, and sensitivity analyses did not identify a dominating study or study characteristic.

Conclusions  Early, intensive statin therapy reduces death and cardiovascular events after 4 months of treatment. The validity of this finding would be strengthened by an analysis of individual patient data.

Author Affiliations: Departments of Internal Medicine (Drs Hulten and George), General Internal Medicine (Drs Jackson and Douglas), and Cardiology (Dr Villines), Walter Reed Army Medical Center, Washington, DC; and Uniformed Services University of the Health Sciences, Bethesda, Md.

CiteULike    Connotea    Delicious    Digg    Facebook    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: The Task Force for the management of acute coronary syndromes (ACS) in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC)
Authors/Task Force Members et al.
Eur Heart J 2011;32:2999-3054.
FULL TEXT  

Benefit of early statin therapy in patients with acute myocardial infarction who have extremely low low-density lipoprotein cholesterol.
Lee et al.
J Am Coll Cardiol 2011;58:1664-1671.
ABSTRACT | FULL TEXT  

Chapter 44 Non-ST-elevation acute coronary syndromes
Ardissino et al.
The ESC Textbook of Acute and Intensive Cardiac Care 2010;1:med-9780199584314-chapter-med-9780199584314-chapter.
ABSTRACT | FULL TEXT  

Part 9: Acute Coronary Syndromes: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations
O'Connor et al.
Circulation 2010;122:S422-S465.
FULL TEXT  

Evidence of Pre-Procedural Statin Therapy: A Meta-Analysis of Randomized Trials
Winchester et al.
J Am Coll Cardiol 2010;56:1099-1109.
ABSTRACT | FULL TEXT  

Six-month survival benefits associated with clinical guideline recommendations in acute coronary syndromes
Chew et al.
Heart 2010;96:1201-1206.
ABSTRACT | FULL TEXT  

Statins in Acute Coronary Syndromes: Do the Guideline Recommendations Match the Evidence?
Morrissey et al.
J Am Coll Cardiol 2009;54:1425-1433.
ABSTRACT | FULL TEXT  

Preoperative Statin Use and Infection after Cardiac Surgery: A Cohort Study
Mohamed et al.
Clinical Infectious Diseases 2009;48:e66-e72.
ABSTRACT | FULL TEXT  

Preventing further vascular events after a stroke or transient ischaemic attack: an update on medical management
Sudlow
PN 2008;8:141-157.
ABSTRACT | FULL TEXT  

The Year in Non ST-Segment Elevation Acute Coronary Syndrome
Giugliano and Braunwald
J Am Coll Cardiol 2007;50:1386-1395.
FULL TEXT  

Guidelines for the diagnosis and treatment of non-ST-segment elevation acute coronary syndromes: The Task Force for the Diagnosis and Treatment of Non-ST-Segment Elevation Acute Coronary Syndromes of the European Society of Cardiology
Authors/Task Force Members et al.
Eur Heart J 2007;28:1598-1660.
FULL TEXT  

The Year in Atherothrombosis
Sanz et al.
J Am Coll Cardiol 2007;49:1740-1749.
FULL TEXT  

Acute coronary syndromes, response to clopidogrel, and worsened cardiovascular outcomes: the hen and the egg dilemma
Serebruany
Eur Heart J 2007;28:640-641.
FULL TEXT  

Evidently. . .
Lehman
Evid. Based Med. 2007;12:8-8.
FULL TEXT  

Other articles noted
Evid. Based Med. 2007;12:31-32.
FULL TEXT