TY - JOUR T1 - Effect of intensive lipid-lowering therapy on mortality after acute coronary syndrome (a patient-level analysis of the Aggrastat to Zocor and Pravastatin or Atorvastatin Evaluation and Infection Therapy-Thrombolysis in Myocardial Infarction 22 trials). AU - Murphy,Sabina A, AU - Cannon,Christopher P, AU - Wiviott,Stephen D, AU - de Lemos,James A, AU - Blazing,Michael A, AU - McCabe,Carolyn H, AU - Califf,Robert M, AU - Braunwald,Eugene, Y1 - 2007/07/18/ PY - 2007/03/22/received PY - 2007/04/27/revised PY - 2007/04/27/accepted PY - 2007/9/22/pubmed PY - 2007/11/6/medline PY - 2007/9/22/entrez SP - 1047 EP - 51 JF - The American journal of cardiology JO - Am J Cardiol VL - 100 IS - 7 N2 - Compared with moderate lipid lowering with standard-dose statin therapy, intensive lipid lowering with high-dose statin therapy after acute coronary syndromes (ACS) significantly reduces cardiovascular events. However, the 2 trials of high-dose versus standard-dose statin therapy in patients with ACS, Aggrastat to Zocor (A to Z) and Pravastatin or Atorvastatin Evaluation and Infection Therapy-Thrombolysis In Myocardial Infarction 22 (PROVE-IT-TIMI 22), were not individually powered to evaluate the impact on mortality alone. In this study, a pooled, patient-level analysis of these trials of 8,658 post-ACS patients was performed to provide a more robust estimate of the impact of intensive statin therapy on mortality. By 8 months, achieved low-density lipoprotein levels were lower in the group with intensive statin therapy (median 64 mg/dl, interquartile range 51 to 81) than in the group with moderate statin therapy (median 87 mg/dl, interquartile range 71 to 107) (p <0.001). All-cause mortality was significantly reduced in the group with intensive statin therapy compared with the group with moderate statin therapy (3.6% vs 4.9%, hazard ratio 0.77, 95% confidence interval 0.63 to 0.95, p = 0.015), without significant interaction by trial (interaction p = 0.63). The reduction in all-cause mortality with intensive statin therapy was consistent across key subgroups. In conclusion, in this analysis of >8,600 patients, intensive lipid lowering with high-dose statin therapy after ACS was associated with reduced mortality compared with moderate lipid lowering with standard-dose statin therapy. On the basis of these findings, 1 death was prevented for every 95 patients treated with high-dose statin therapy for 2 years. The results of this pooled analysis provide further evidence for early intensive statin therapy after ACS. SN - 0002-9149 UR - https://www.unboundmedicine.com/medline/citation/17884359/Effect_of_intensive_lipid_lowering_therapy_on_mortality_after_acute_coronary_syndrome__a_patient_level_analysis_of_the_Aggrastat_to_Zocor_and_Pravastatin_or_Atorvastatin_Evaluation_and_Infection_Therapy_Thrombolysis_in_Myocardial_Infarction_22_trials__ DB - PRIME DP - Unbound Medicine ER -