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Am Fam Physician. 2006;74(5):824-827

Clinical Question: Does early initiation of statin therapy following the onset of acute coronary syndrome (ACS) reduce the short-term risk of death, recurrent myocardial infarction (MI), or stroke?

Setting: Various (meta-analysis)

Study Design: Meta-analysis (randomized controlled trials)

Synopsis: During the initial period following the onset of ACS, the risk is high for recurrent events and death caused by vessel occlusions from vulnerable coronary plaques. To study the effectiveness of statins in reducing the short-term risk of adverse clinical outcomes, the investigators searched (without any language restrictions) electronic databases including the Cochrane Registry, reference lists of identified articles, recently published editorials, and topical reviews, and they contacted authors of significant publications. Eligibility criteria included randomized trial design comparing statin treatment with usual care, initiation of treatment within 14 days of onset of ACS, and follow-up for at least 30 days. Two authors independently assessed trial eligibility and quality. Twelve studies, including 13,024 individuals with mean ages ranging from 53 to 69 years, met inclusion criteria. Early statin therapy did not significantly reduce the risk of death, MI, or stroke at one or four months following ACS. In addition, there were no significant risk reductions for secondary outcomes including total death, total MI, total stroke, cardiovascular death, fatal or nonfatal MI, or revascularization procedures. The authors found no evidence for heterogeneity among the studies (i.e., the results were similar among all the trials). A formal analysis found little evidence for publication bias.

Bottom Line: Early initiation of statin therapy within 14 days of the onset of ACS does not reduce the risk of death, recurrent MI, or stroke up to four months. (Level of Evidence: 1a)

POEMs (patient-oriented evidence that matters) are provided by Essential Evidence Plus, a point-of-care clinical decision support system published by Wiley-Blackwell. For more information, see http://www.essentialevidenceplus.com. Copyright Wiley-Blackwell. Used with permission.

For definitions of levels of evidence used in POEMs, see http://www.essentialevidenceplus.com/product/ebm_loe.cfm?show=oxford.

To subscribe to a free podcast of these and other POEMs that appear in AFP, search in iTunes for “POEM of the Week” or go to http://goo.gl/3niWXb.

This series is coordinated by Sumi Sexton, MD, editor-in-chief.

A collection of POEMs published in AFP is available at https://www.aafp.org/afp/poems.

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Copyright © 2006 by the American Academy of Family Physicians.

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