Does intensive statin therapy lower mortality and cardiovascular event risk in patients with acute coronary syndrome?

Steven E Nissen

This article has no abstract so we have provided the first paragraph of the full text.

The A to Z trial by de Lemos et al. provides useful insights into both the benefits and risks of high-dose simvastatin therapy after ACS. The study randomized 4,497 patients within 5 days of MI or ACS to two treatment regimens: 40 mg simvastatin daily for 1 month followed by 80 mg thereafter or placebo for 4 months followed by 20 mg simvastatin daily. After 24 months, there was a nonsignificant 11% reduction in cardiovascular events (P = 0.14), including death, nonfatal MI, readmission for ACS or stroke. Surprisingly, although the difference in LDL cholesterol was 1.6 mM/l (62 mg/dl) after the first 4 months treatment, there was no reduction in adverse outcomes. Subsequently, the event curves showed gradual separation and a trend towards statistical significance by the end of the 24-month follow-up period. These findings contrasted with earlier statin trials in ACS patients. MIRACL¹ and PROVE-IT,² for example, both showed significant reductions in cardiovascular events for patients receiving aggressive statin therapy. MIRACL compared 80 mg atorvastatin with placebo, demonstrating a 16% reduction in cardiovascular events (P = 0.048). PROVE-IT compared 80 mg atorvastatin with 40 mg pravastatin for 24 months following an acute event and also showed a 16% reduction in adverse cardiovascular outcomes (P = 0.005).

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