Cannon CP, Braunwald E, McCabe, CH, et al: Intensive versus moderate lipid lowering with statins after acute coronary syndromes. N Engl J Med 2004;350(15):1495-504.
Topol EJ: Intensive statin therapy-a change in cardiovascular prevention. N Engl J Med 2004;350(15):1562-4.(editorial)
This randomized trial confirmed the benefits of early and aggressive lipid lowering therapy among patients who have had an acute coronary syndrome. The study involved 4,162 patients who had been hospitalized for an acute coronary syndrome. The patients were randomly assigned to receive 40 mg of pravastatin daily (standard therapy) or 80 mg of atorvastatin daily (intensive therapy). After 2 years of follow-up, the median LDL cholesterol level for the standard group was 95 mg/dL compared to 62 mg/dL in the intensive therapy group (P <0.001). The intensive therapy group had 28% fewer deaths and 16% fewer combined major cardiovascular events. The reduced clinical events were evident as early as 30 days after the start of therapy. It is not clear whether the long-term benefits were due to ongoing intensive lipid-lowering therapy or whether they resulted from an early benefit of stabilizing vulnerable plaques. These results suggest that after an acute coronary syndrome, the optimal LDL cholesterol may be lower than the current guidelines of <100 mg/dL.