Statins for acute coronary syndrome.

Family Medicine, St Mary's Hospital, McGill University, 377 Rue Jean Brilliant, Montreal, Quebec, Canada, H3T 1M5.
Cochrane database of systematic reviews (Online) (Impact Factor: 5.7). 01/2011; DOI: 10.1002/14651858.CD006870.pub2
Source: PubMed

ABSTRACT The early period following the onset of acute coronary syndromes (ACS) represents a critical stage of coronary heart disease with a high risk for recurrent events and deaths. The short-term effects of early treatment with statins in patients suffering from ACS on patient-relevant outcomes are unclear.
To assess the benefits and harms of early administered statins in patients with ACS from randomized controlled trials (RCTs).
We searched CENTRAL, MEDLINE, EMBASE, and CINAHL (to 1 February 2010). No language restrictions were applied. We supplemented the search by contacting experts in the field, by reviewing reference lists of reviews and editorials on the topic, and by searching trial registries.
RCTs comparing statins with placebo or usual care, initiation of statin therapy within 14 days following the onset of ACS, and follow-up of at least 30 days reporting at least one clinical outcome.
Two authors independently assessed study quality and extracted data. We pooled treatment effects and calculated risk ratios (RRs) for all outcomes in the treatment and control groups using a random effects model.
Eighteen studies (14,303 patients) compared early statin treatment versus placebo or usual care in patients with ACS. 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 (risk ratio (RR) 0.93, 95% confidence interval (CI) 0.80 to 1.08) and four months (RR 0.93, 95% CI 0.81 to 1.06) of follow-up. 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 four 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 four months following ACS (RR 0.76, 95% CI 0.59 to 0.96). 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. Serious muscle toxicity was mostly limited to patients treated with simvastatin 80 mg.
Based on available evidence, initiation of statin therapy within 14 days following ACS does not reduce death, myocardial infarction, or stroke up to four months, but reduces the occurrence of unstable angina at four months following ACS.

1 Bookmark
  • [Show abstract] [Hide abstract]
    ABSTRACT: Hintergrund Bestimmte Arzneistoffe gelten als potenziell ungeeignet für geriatrische Patienten; auf ihren Einsatz sollte möglichst verzichtet werden. Potenziell inadäquate Medikationen (PIM) wurden zu unterschiedlichen PIM-Listen zusammengefasst. 2010 erschien die deutsche PRISCUS-Liste. Ziel der vorliegenden Untersuchung ist die Bewertung der PRISCUS-Liste im Vergleich mit internationalen PIM-Listen. Material und Methoden Basierend auf ausgewählten PIM-Listen (PRISCUS, STOPP/START, Beers) wurde die Medikation von 308 Patienten einer geriatrischen Rehabilitationsklinik auf PIM untersucht. Einschlusskriterium der Patienten war ein Alter von ≥ 65 Jahren. Ergebnisse Bezüglich ermittelter PIM unterlag die PRISCUS-Liste quantitativ den STOPP-Kriterien. Während des Aufenthalts erhielt jeder Patient durchschnittlich 1,2 PIM gemäß STOPP-Kriterien und 0,5 PIM nach der PRISCUS-Liste. Die geringste Anzahl lieferte die Beers-Liste (0,4 PIM). Schlussfolgerung Vom Einsatz der Beers-Liste sollte wegen der fehlenden Anpassung an den deutschen Arzneimittelmarkt abgesehen werden. Eine Anpassung der PRISCUS-Liste um diagnoseabhängige STOPP-Kriterien könnte dazu beitragen, Therapieerfolg und Arzneimitteltherapiesicherheit bei geriatrischen Patienten wesentlich zu verbessern.
    Zeitschrift für Gerontologie + Geriatrie 46(1). · 0.74 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: It has repeatedly been shown that statins decrease morbidity and mortality in patients with atherosclerosis, thus supporting their use for the primary and secondary prevention of ischemic heart disease. Different pathological pathways that are triggered in the setting of acute coronary syndrome (ACS), such as endothelial dysfunction, activation of inflammatory and coagulation cascades, and thrombus formation, are known to be inhibited by statins, thereby justifying the use of these agents in patients with ACS. Several recent prospective controlled clinical trials have demonstrated the safety and, in some cases, the efficacy of statins when administered early after ACS. An increasing number of publications have reported, however, that statins may confer a beneficial effect not only in early secondary prevention, but also in the direct treatment of ACS (ie, when statins are administered as first-line treatment in clinically unstable patients). This therapeutic option is supported by the following: numerous experimental studies demonstrating a protective effect of statins under conditions of acute ischemia; analysis of different registries and trials, which has demonstrated a more favourable prognosis for statin-treated patients at the time of acute myocardial ischemia; and small clinical trials reporting a lower periprocedural infarction rate during coronary intervention or lower levels of several prognostic biomarkers, in addition to a lower incidence of cardiovascular events associated with statin therapy. Nevertheless, confirmation of this hypothesis in large prospective controlled clinical trials will be necessary before the implementation of statins as first-line therapy in unstable patients with ACS, irrespective of blood cholesterol levels.
    Experimental and clinical cardiology 01/2012; 17(4):227-236. · 1.10 Impact Factor


Available from
May 15, 2014