Cochrane corner: early statin therapy in acute coronary syndromes—what is the clinical benefit?

The time period shortly after an acute coronary syndrome (ACS) is critical for patients with coronary heart disease. Pathophysiologically, endothelial dysfunction of arteries, platelet aggregability, thrombus formation and vascular inflammation increase the risk for recurrent events and death due to vessel occlusion from vulnerable coronary plaques. Thanks to their pleiotropic effects, statins may improve these unfavourable pathophysiological mechanisms and hereby reduce the risk of further ischaemic cardiovascular events.1 A recent Cochrane systematic review assessed the effects of early administered statins on mortality, cardiovascular morbidity and adverse events such as myopathy of patients with ACS. The review included 18 controlled trials that randomised >14 000 patients to early statin treatment (initiation within 14 days of ACS onset) or placebo/usual care.2 The overall quality of the evidence was moderate because of concerns about risk of bias and imprecision of summary estimates. Early statin therapy did not significantly reduce the risk for the combined primary outcome of death, non-fatal myocardial infarction and stroke at 1 month (risk ratio (RR) 0.93, 95% CI 0.80 to 1.08) nor at 4 months of follow-up …