Statins for acute coronary syndrome

Noah Vale, Alain J. Nordmann, Gregory G. Schwartz, James A de Lemos, Furio Colivicchi, Frank den Hartog, Petr Ostadal, Stella M. Macin, Anho H. Liem, Edward J. Mills, Neera Bhatnagar, Heiner C. Bucher, Matthias Briel

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

BACKGROUND: The early period following the onset of acute coronary syndrome (ACS) represents a critical stage of coronary heart disease, with a high risk of recurrent events and deaths. The short-term effects of early treatment with statins on patient-relevant outcomes in patients suffering from ACS are unclear. This is an update of a review previously published in 2011.

OBJECTIVES: To assess the effects, both harms and benefits, of early administered statins in patients with ACS, in terms of mortality and cardiovascular events.

SEARCH METHODS: We updated the searches of CENTRAL (2013, Issue 3), MEDLINE (Ovid) (1946 to April Week 1 2013), EMBASE (Ovid) (1947 to 2013 Week 14), and CINAHL (EBSCO) (1938 to 2013) on 12 April 2013. We applied no language restrictions. We supplemented the search by contacting experts in the field, by reviewing the reference lists of reviews and editorials on the topic, and by searching trial registries.

SELECTION CRITERIA: Randomized controlled trials (RCTs) comparing statins with placebo or usual care, with initiation of statin therapy within 14 days following the onset of ACS, follow-up of at least 30 days, and reporting at least one clinical outcome.

DATA COLLECTION AND ANALYSIS: Two authors independently assessed risk of bias and extracted data. We calculated risk ratios (RRs) for all outcomes in the treatment and control groups and pooled data using random-effects models.

MAIN RESULTS: Eighteen studies (14,303 patients) compared early statin treatment versus placebo or no treatment in patients with ACS. The new search did not identify any new studies for inclusion. There were some concerns about risk of bias and imprecision of summary estimates. Based on moderate quality evidence, early statin therapy did not decrease the combined primary outcome of death, non-fatal myocardial infarction, and stroke at one month (risk ratio (RR) 0.93, 95% confidence interval (CI) 0.80 to 1.08) or four months (RR 0.93, 95% CI 0.81 to 1.06) of follow-up when compared to placebo or no treatment. There were no statistically significant risk reductions from statins for total death, total myocardial infarction, total stroke, cardiovascular death, revascularization procedures, and acute heart failure at one month or at four months, although there were favorable trends related to statin use for each of these endpoints. Moderate quality evidence suggests that the incidence 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 more than 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.

AUTHORS' CONCLUSIONS: Based on moderate quality evidence, due to concerns about risk of bias and imprecision, 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. Serious side effects were rare.

Original languageEnglish (US)
Pages (from-to)CD006870
JournalThe Cochrane database of systematic reviews
Volume9
DOIs
StatePublished - 2014

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Hydroxymethylglutaryl-CoA Reductase Inhibitors
Acute Coronary Syndrome
Odds Ratio
Myocardial Infarction
Unstable Angina
Placebos
Confidence Intervals
Therapeutics
Stroke
Control Groups
Simvastatin
Muscular Diseases
Risk Reduction Behavior
Secondary Prevention
MEDLINE
Coronary Disease
Registries
Creatinine
Phosphotransferases
Language

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Vale, N., Nordmann, A. J., Schwartz, G. G., de Lemos, J. A., Colivicchi, F., den Hartog, F., ... Briel, M. (2014). Statins for acute coronary syndrome. The Cochrane database of systematic reviews, 9, CD006870. https://doi.org/10.1002/14651858.CD006870.pub3

Statins for acute coronary syndrome. / Vale, Noah; Nordmann, Alain J.; Schwartz, Gregory G.; de Lemos, James A; Colivicchi, Furio; den Hartog, Frank; Ostadal, Petr; Macin, Stella M.; Liem, Anho H.; Mills, Edward J.; Bhatnagar, Neera; Bucher, Heiner C.; Briel, Matthias.

In: The Cochrane database of systematic reviews, Vol. 9, 2014, p. CD006870.

Research output: Contribution to journalArticle

Vale, N, Nordmann, AJ, Schwartz, GG, de Lemos, JA, Colivicchi, F, den Hartog, F, Ostadal, P, Macin, SM, Liem, AH, Mills, EJ, Bhatnagar, N, Bucher, HC & Briel, M 2014, 'Statins for acute coronary syndrome', The Cochrane database of systematic reviews, vol. 9, pp. CD006870. https://doi.org/10.1002/14651858.CD006870.pub3
Vale, Noah ; Nordmann, Alain J. ; Schwartz, Gregory G. ; de Lemos, James A ; Colivicchi, Furio ; den Hartog, Frank ; Ostadal, Petr ; Macin, Stella M. ; Liem, Anho H. ; Mills, Edward J. ; Bhatnagar, Neera ; Bucher, Heiner C. ; Briel, Matthias. / Statins for acute coronary syndrome. In: The Cochrane database of systematic reviews. 2014 ; Vol. 9. pp. CD006870.
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abstract = "BACKGROUND: The early period following the onset of acute coronary syndrome (ACS) represents a critical stage of coronary heart disease, with a high risk of recurrent events and deaths. The short-term effects of early treatment with statins on patient-relevant outcomes in patients suffering from ACS are unclear. This is an update of a review previously published in 2011.OBJECTIVES: To assess the effects, both harms and benefits, of early administered statins in patients with ACS, in terms of mortality and cardiovascular events.SEARCH METHODS: We updated the searches of CENTRAL (2013, Issue 3), MEDLINE (Ovid) (1946 to April Week 1 2013), EMBASE (Ovid) (1947 to 2013 Week 14), and CINAHL (EBSCO) (1938 to 2013) on 12 April 2013. We applied no language restrictions. We supplemented the search by contacting experts in the field, by reviewing the reference lists of reviews and editorials on the topic, and by searching trial registries.SELECTION CRITERIA: Randomized controlled trials (RCTs) comparing statins with placebo or usual care, with initiation of statin therapy within 14 days following the onset of ACS, follow-up of at least 30 days, and reporting at least one clinical outcome.DATA COLLECTION AND ANALYSIS: Two authors independently assessed risk of bias and extracted data. We calculated risk ratios (RRs) for all outcomes in the treatment and control groups and pooled data using random-effects models.MAIN RESULTS: Eighteen studies (14,303 patients) compared early statin treatment versus placebo or no treatment in patients with ACS. The new search did not identify any new studies for inclusion. There were some concerns about risk of bias and imprecision of summary estimates. Based on moderate quality evidence, early statin therapy did not decrease the combined primary outcome of death, non-fatal myocardial infarction, and stroke at one month (risk ratio (RR) 0.93, 95{\%} confidence interval (CI) 0.80 to 1.08) or four months (RR 0.93, 95{\%} CI 0.81 to 1.06) of follow-up when compared to placebo or no treatment. There were no statistically significant risk reductions from statins for total death, total myocardial infarction, total stroke, cardiovascular death, revascularization procedures, and acute heart failure at one month or at four months, although there were favorable trends related to statin use for each of these endpoints. Moderate quality evidence suggests that the incidence 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 more than 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.AUTHORS' CONCLUSIONS: Based on moderate quality evidence, due to concerns about risk of bias and imprecision, 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. Serious side effects were rare.",
author = "Noah Vale and Nordmann, {Alain J.} and Schwartz, {Gregory G.} and {de Lemos}, {James A} and Furio Colivicchi and {den Hartog}, Frank and Petr Ostadal and Macin, {Stella M.} and Liem, {Anho H.} and Mills, {Edward J.} and Neera Bhatnagar and Bucher, {Heiner C.} and Matthias Briel",
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TY - JOUR

T1 - Statins for acute coronary syndrome

AU - Vale, Noah

AU - Nordmann, Alain J.

AU - Schwartz, Gregory G.

AU - de Lemos, James A

AU - Colivicchi, Furio

AU - den Hartog, Frank

AU - Ostadal, Petr

AU - Macin, Stella M.

AU - Liem, Anho H.

AU - Mills, Edward J.

AU - Bhatnagar, Neera

AU - Bucher, Heiner C.

AU - Briel, Matthias

PY - 2014

Y1 - 2014

N2 - BACKGROUND: The early period following the onset of acute coronary syndrome (ACS) represents a critical stage of coronary heart disease, with a high risk of recurrent events and deaths. The short-term effects of early treatment with statins on patient-relevant outcomes in patients suffering from ACS are unclear. This is an update of a review previously published in 2011.OBJECTIVES: To assess the effects, both harms and benefits, of early administered statins in patients with ACS, in terms of mortality and cardiovascular events.SEARCH METHODS: We updated the searches of CENTRAL (2013, Issue 3), MEDLINE (Ovid) (1946 to April Week 1 2013), EMBASE (Ovid) (1947 to 2013 Week 14), and CINAHL (EBSCO) (1938 to 2013) on 12 April 2013. We applied no language restrictions. We supplemented the search by contacting experts in the field, by reviewing the reference lists of reviews and editorials on the topic, and by searching trial registries.SELECTION CRITERIA: Randomized controlled trials (RCTs) comparing statins with placebo or usual care, with initiation of statin therapy within 14 days following the onset of ACS, follow-up of at least 30 days, and reporting at least one clinical outcome.DATA COLLECTION AND ANALYSIS: Two authors independently assessed risk of bias and extracted data. We calculated risk ratios (RRs) for all outcomes in the treatment and control groups and pooled data using random-effects models.MAIN RESULTS: Eighteen studies (14,303 patients) compared early statin treatment versus placebo or no treatment in patients with ACS. The new search did not identify any new studies for inclusion. There were some concerns about risk of bias and imprecision of summary estimates. Based on moderate quality evidence, early statin therapy did not decrease the combined primary outcome of death, non-fatal myocardial infarction, and stroke at one month (risk ratio (RR) 0.93, 95% confidence interval (CI) 0.80 to 1.08) or four months (RR 0.93, 95% CI 0.81 to 1.06) of follow-up when compared to placebo or no treatment. There were no statistically significant risk reductions from statins for total death, total myocardial infarction, total stroke, cardiovascular death, revascularization procedures, and acute heart failure at one month or at four months, although there were favorable trends related to statin use for each of these endpoints. Moderate quality evidence suggests that the incidence 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 more than 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.AUTHORS' CONCLUSIONS: Based on moderate quality evidence, due to concerns about risk of bias and imprecision, 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. Serious side effects were rare.

AB - BACKGROUND: The early period following the onset of acute coronary syndrome (ACS) represents a critical stage of coronary heart disease, with a high risk of recurrent events and deaths. The short-term effects of early treatment with statins on patient-relevant outcomes in patients suffering from ACS are unclear. This is an update of a review previously published in 2011.OBJECTIVES: To assess the effects, both harms and benefits, of early administered statins in patients with ACS, in terms of mortality and cardiovascular events.SEARCH METHODS: We updated the searches of CENTRAL (2013, Issue 3), MEDLINE (Ovid) (1946 to April Week 1 2013), EMBASE (Ovid) (1947 to 2013 Week 14), and CINAHL (EBSCO) (1938 to 2013) on 12 April 2013. We applied no language restrictions. We supplemented the search by contacting experts in the field, by reviewing the reference lists of reviews and editorials on the topic, and by searching trial registries.SELECTION CRITERIA: Randomized controlled trials (RCTs) comparing statins with placebo or usual care, with initiation of statin therapy within 14 days following the onset of ACS, follow-up of at least 30 days, and reporting at least one clinical outcome.DATA COLLECTION AND ANALYSIS: Two authors independently assessed risk of bias and extracted data. We calculated risk ratios (RRs) for all outcomes in the treatment and control groups and pooled data using random-effects models.MAIN RESULTS: Eighteen studies (14,303 patients) compared early statin treatment versus placebo or no treatment in patients with ACS. The new search did not identify any new studies for inclusion. There were some concerns about risk of bias and imprecision of summary estimates. Based on moderate quality evidence, early statin therapy did not decrease the combined primary outcome of death, non-fatal myocardial infarction, and stroke at one month (risk ratio (RR) 0.93, 95% confidence interval (CI) 0.80 to 1.08) or four months (RR 0.93, 95% CI 0.81 to 1.06) of follow-up when compared to placebo or no treatment. There were no statistically significant risk reductions from statins for total death, total myocardial infarction, total stroke, cardiovascular death, revascularization procedures, and acute heart failure at one month or at four months, although there were favorable trends related to statin use for each of these endpoints. Moderate quality evidence suggests that the incidence 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 more than 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.AUTHORS' CONCLUSIONS: Based on moderate quality evidence, due to concerns about risk of bias and imprecision, 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. Serious side effects were rare.

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