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REVIEWARTICLE
TheEffectofEarly,IntensiveStatinTherapy
onAcuteCoronarySyndrome
AMeta-analysisofRandomizedControlledTrials

EddieHulten,MD,MPH;JeffreyL.Jackson,MD,MPH;KevinDouglas,MD,MPH;
SusanGeorge,MD;ToddC.Villines,MD


Background:Inadditiontowell-establishedsecond-stractedstudyquality,characteristics,andoutcomes.
arypreventionbenefitsforatheroscleroticcoronary
arterydisease,3-hydroxy-3-methylglutarylcoenzymeDataSynthesis:Thirteenrandomizedcontrolledtrials
A(HMG-CoA)reductaseinhibitors(statins)arepublishedbeforeMay2006wereavailable,involving
hypothesizedtohaveshort-termbenefitinacutecoro-17963adults(mediannumberofpatients,135;median
narysyndrome(ACS),yetthedataareinconsistent,withfollow-up,6months).Early,intensivestatintherapyfor
sometrialsunderpoweredtodemonstratetherapeuticACSdecreasedtherateofdeathandcardiovascularevents
benefit.Ourobjectivewastodeterminetheeffectsofover2yearsoffollow-up(hazardratio,0.81[95%con-
Ͻ2
early,intensivestatintherapyforACS.fidenceinterval,0.77-0.87])(Q3=58.54;P.001;I=95%).
Survivalcurvesrevealedthatthisbenefitbeginstooc-
DataSources:StudiesfoundinthePubMed,MEDLINE,curbetween4and12months,achievingstatisticalsig-
EMBASE,BIOSIS,SciSearch,PASCAL,andInterna-nificanceby12months.Therewasnoevidenceofpub-
tionalPharmaceuticalAbstracts(IPA)databasesandthelicationbias,andsensitivityanalysesdidnotidentifya
CochraneControlledTrialsRegisterpublishedbetweendominatingstudyorstudycharacteristic.
January1974andMay2006.
Conclusions:Early,intensivestatintherapyreducesdeath
andcardiovasculareventsafter4monthsoftreatment.
StudySelection:Randomizedcontrolledtrialsofstat-
Thevalidityofthisfindingwouldbestrengthenedbyan
insbegunwithin14daysofhospitalizationforACSwere
analysisofindividualpatientdata.
included.

DataExtraction:Twoinvestigatorsindependentlyab-ArchInternMed.2006;166:1814-1821

-HYDROXY-3-METHYLGLU-inflammation,antithrombogenicity,
tarylcoenzymeA(HMG-enhancedarterialcompliance,bloodpres-
CoA)reductaseinhibitorssurereduction,andmodulationofendo-
(st