Review: high dose statins reduce risk of non-fatal cardiovascular events more than standard dose statins

doi:10.1136/ebm.12.2.42

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Evidence-Based Medicine 2007;12:42; doi:10.1136/ebm.12.2.42
Copyright © 2007 by the BMJ Publishing Group Ltd.

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Therapeutics

Review: high dose statins reduce risk of non-fatal cardiovascular events more than standard dose statins

Cannon CP, Steinberg BA, Murphy SA, et al. Meta-analysis of cardiovascular outcomes trials comparing intensive versus moderate statin therapy. J Am Coll Cardiol 2006;48:438–45.[Abstract/Free Full Text]

Q What is the relative effectiveness of high dose and standard dose statin therapy for reduction of cardiovascular events?

Clinical impact ratings GP/FP/Primary care $*$ $*$ $*$ $*$ $*$ $*$ ${star}$ IM/Ambulatory care $*$ $*$ $*$ $*$ $*$ $*$ ${star}$ Cardiology $*$ $*$ $*$ $*$ $*$ ${star}$ ${star}$

Key Words: coronary disease • hydroxymethylglutaryl-CoA reductase inhibitors

The first 150 words of the full text of this article appear below.

METHODS
Data sources: PubMed and reference lists of original studies and reviews.

Study selection and assessment: randomised controlled trials (RCTs) that compared intensiveand standard dose statin therapy, enrolled >1000 patients,and reported clinical outcomes as primary end points. 4 trials(27 548 patients with stable coronary heart disease or acutecoronary syndromes) met the selection criteria: PROVE IT-TIMI-22(n = 4162), A-to-Z (n = 4497), TNT (n = 10 001), and IDEAL (n= 8888). Standard dose statins assessed were pravastatin, 40mg; atorvastatin, 10 mg; simvastatin, 20 mg; and simvastatin,20 mg, titrated to 40 mg. High dose statins were atorvastatin,80 mg (3 trials) and simvastatin 40 mg, then 80 mg.

Outcomes: combined outcome of non-fatal myocardial infarction (MI) orcoronary death; combined outcome of any cardiovascular event(MI, stroke, hospital admission for unstable angina, or revascularisation)or coronary death; cardiovascular, non-cardiovascular, and allcause mortality; and stroke.

MAIN RESULTS
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L Kristin Newby, MD, MHS

Duke University Medical Center, Durham, North Carolina, USA