Systematic analysis of data from a number of trials shows that early intensive use of statins reduces risk of major cardiovascular events and death when started within 14 days of hospitalization for an acute coronary syndrome event, according to an article in the September 25 issue of the Archives of Internal Medicine.

Although the benefit of statins to lower cholesterol levels is clear, it is less clear whether these drugs provide short-term benefit when given immediately to patients hospitalized for acute coronary syndrome. In addition to reducing cholesterol, statins may stabilize the amount of plaque build-up in arteries, reduce inflammation, prevent coagulation, reduce blood pressure and improve function of blood vessels, all of which could improve outcomes for patients with acute coronary syndrome.

Eddie Hulten, MD, MPH, and colleagues at the Uniformed Services University of the Health Sciences, Bethesda, Maryland, analyzed the results of 13 previous clinical trials of intensive statin therapy begun within 14 days of hospitalization for acute coronary syndrome involving 17,963 adults with acute coronary syndrome. The studies compared intensive (high-dose) statins with low-dose statins or placebo for four months followed by a lower dose of statins, placebo alone or usual care per the treating physicians’ discretion. The participants had an average age of 60 years, and 76 percent were male.

“This systematic review provides evidence that early, intensive therapy with statins is associated with a reduction of adverse cardiovascular outcomes, particularly cardiovascular death, unstable angina and revascularization when prescribed within 14 days of hospitalization for acute coronary syndrome,” the authors wrote. “These benefits took more than four months to begin to accrue and were sustained for two years. During these two years, there was slightly less than a 20-percent reduction in the risk of experiencing an adverse coronary event.” The results could not be explained by a cholesterol-lowering effect.

Overall, statins were about as safe and tolerable as the control treatments. Of 17,963 patients, three developed rhabdomyolysis; some studies showed a slightly higher risk of hepatitis among individuals taking statins.

“Use of intensive statin therapy is often avoided by clinicians owing to fear of increased adverse events due to the higher statin dose or, in patients with only mild elevations in LDL-C level, of driving LDL-C level below a theoretical safe value,” the authors continued. “Our study showed that intensive statin therapy and controls experienced comparable rates of hepatitis, myositis and rhabdomyolysis. Serious adverse events were rare.”

The statin regimen with the most evidence of effectiveness was an 80-milligram dose of atorvastatin, begun within 14 days of hospitalization for acute coronary syndrome, they concluded.