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

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

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Embedded ImageData sources:

PubMed and reference lists of original studies and reviews.

Embedded ImageStudy selection and assessment:

randomised controlled trials (RCTs) that compared intensive and 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 acute coronary 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, 40 mg; 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.

Embedded ImageOutcomes:

combined …

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  • For correspondence: Dr C P Cannon, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA. cpcannon{at}

  • Sources of funding: Bristol-Myers Squibb, Sankyo Co Ltd, Merck, AstraZeneca and Schering-Plough and Pfizer.