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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 ★★★★★★☆ IM/Ambulatory care ★★★★★★☆ Cardiology ★★★★★☆☆
PubMed and reference lists of original studies and reviews.
Study 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.
For correspondence: Dr C P Cannon, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA.
Sources of funding: Bristol-Myers Squibb, Sankyo Co Ltd, Merck, AstraZeneca and Schering-Plough and Pfizer.