Document Detail

Meta-analysis of cardiovascular outcomes trials comparing intensive versus moderate statin therapy.
MedLine Citation:
PMID:  16875966     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: The purpose of this study was to conduct a meta-analysis that compares the reduction of cardiovascular outcomes with high-dose statin therapy versus standard dosing. BACKGROUND: Debate exists regarding the merit of more intensive lipid lowering with high-dose statin therapy as compared with standard-dose therapy. METHODS: We searched PubMed and article references for randomized controlled trials of intensive versus standard-dose statin therapy enrolling more than 1,000 patients with either stable coronary heart disease or acute coronary syndromes. Four trials were identified: the TNT (Treating to New Targets) and the IDEAL (Incremental Decrease in End Points Through Aggressive Lipid-Lowering) trials involved patients with stable cardiovascular disease, and the PROVE IT-TIMI-22 (Pravastatin or Atorvastatin Evaluation and Infection Therapy-Thrombolysis in Myocardial Infarction-22) and A-to-Z (Aggrastat-to-Zocor) trials involved patients with acute coronary syndromes. We carried out a meta-analysis of the relative odds on the basis of a fixed-effects model using the Mantel-Haenszel method for the major outcomes of death and cardiovascular events. RESULTS: A total of 27,548 patients were enrolled in the 4 large trials. The combined analysis yielded a significant 16% odds reduction in coronary death or myocardial infarction (p < 0.00001), as well as a significant 16% odds reduction of coronary death or any cardiovascular event (p < 0.00001). No difference was observed in total or non-cardiovascular mortality, but a trend toward decreased cardiovascular mortality (odds reduction 12%, p = 0.054) was observed. CONCLUSIONS: Intensive lipid lowering with high-dose statin therapy provides a significant benefit over standard-dose therapy for preventing predominantly non-fatal cardiovascular events.
Christopher P Cannon; Benjamin A Steinberg; Sabina A Murphy; Jessica L Mega; Eugene Braunwald
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Publication Detail:
Type:  Journal Article; Meta-Analysis; Research Support, Non-U.S. Gov't     Date:  2006-07-12
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  48     ISSN:  1558-3597     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  2006 Aug 
Date Detail:
Created Date:  2006-07-31     Completed Date:  2006-08-16     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  438-45     Citation Subset:  AIM; IM    
Thrombolysis In Myocardial Infarction Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115, USA.
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MeSH Terms
Cardiovascular Diseases / prevention & control
Coronary Disease / drug therapy*
Dose-Response Relationship, Drug
Hydroxymethylglutaryl-CoA Reductase Inhibitors / administration & dosage*,  therapeutic use
Randomized Controlled Trials as Topic
Treatment Outcome
Reg. No./Substance:
0/Hydroxymethylglutaryl-CoA Reductase Inhibitors
Comment In:
Rev Cardiovasc Med. 2006 Fall;7(4):248-50   [PMID:  17224870 ]
Evid Based Med. 2007 Apr;12(2):42   [PMID:  17400634 ]
J Am Coll Cardiol. 2007 Apr 3;49(13):1502; author reply 1502-3   [PMID:  17397683 ]

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