Statins for acute coronary syndrome

Initiation of statin therapy within 14 days following acute coronary syndrome (ACS) appears to reduce the occurrence of unstable angina but may not reduce death, myocardial infarction, or stroke up to four months following ACS.

Comment: The quality of evidence is downgraded by study quality (unclear allocation concealment).

Summary

A Cochrane review included 18 studies with a total of 14 303 subjects. Compared to placebo or usual care, early statin therapy did not decrease the combined primary outcome of death, non-fatal myocardial infarction (MI), and stroke at one month (RR 0.93, 95% CI 0.80 to 1.08; 13 studies, n=13 484) and four months (RR 0.93, 95% CI 0.81 to 1.06; 11 studies, n=9 625) of follow-up in patients with acute coronary syndrome (ACS). There were no statistically significant risk reductions from statins for total death, total MI, total stroke, cardiovascular death, revascularization procedures, and acute heart failure at one month and at 4 months, although there were favorable trends related to statin use for each of these endpoints. The incidence of episodes of unstable angina was significantly reduced at 4 months following ACS (RR 0.76, 95% CI 0.59 to 0.96; 9 studies, n=8 770). There were nine individuals with myopathy (elevated creatinine kinase levels > 10 times the upper limit of normal) in statin treated patients (0.13%) versus one (0.015%) in the control groups (RR 4.69, 95% CI 1.01 to 21.67; 3 studies, n=4 677). Serious muscle toxicity was mostly limited to patients treated with simvastatin 80 mg.

Clinical comments

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Ədəbiyyat

1. Vale N, Nordmann AJ, Schwartz GG et al. Statins for acute coronary syndrome. Cochrane Database Syst Rev 2014;(9):CD006870. .