Intensive statin therapy in acute coronary syndromes and stable coronary heart disease: a comparative meta-analysis of randomised controlled trials

Background: Intensive statin therapy reduces major adverse cardiovascular events (MACE), but the effect on mortality is unclear. Objective: To determine whether intensive statin therapy reduces all-cause mortality compared with moderate statin therapy in patients with recent acute coronary syndromes (ACS) and stable coronary heart disease (CHD). Methods: Medline, Embase, the Cochrane Database, the internet, and conference proceedings from 1966 to 2006 were searched to identify relevant trials. Selection criteria were randomised allocation to intensive statin therapy (atorvastatin 80 mg/day, simvastatin 80 mg/day, or rosuvastatin 20 - 40 mg/day) versus moderate statin therapy, recent ACS or stable CHD at the time of randomisation, and >= 6 months of follow- up. Results: Six trials, encompassing 110 271 patient-years, were pooled. In patients with recent ACS, intensive statin therapy reduced all- cause mortality from 4.6% to 3.5% over 2.0 years (OR = 0.75, 95% CI 0.61 to 0.93). In patients with stable CHD, intensive statin therapy had no effect on all-cause mortality over 4.7 years (OR = 0.99, 95% CI 0.89 to 1.11). Overall, intensive statin therapy was associated with a reduction in MACE (OR = 0.84, 95% CI 0.77 to 0.91) and admissions to hospital for heart failure (OR = 0.72, 95% CI 0.62 to 0.83). Intensive statin therapy was also associated with an increase in hepatic transaminases > 3 times normal (OR = 3.73, 95% CI 2.11 to 6.58) and a trend towards increased creatine kinase > 10 times normal and/or rhabdomyolysis (OR = 1.96, 95% CI 0.50 to 7.63). Conclusions: Compared with moderate statin therapy, intensive statin therapy reduces all- cause mortality in patients with recent ACS but not in patients with stable CHD.