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Clinical Question: Does high-dose statin therapy provide additional benefit over moderate doses in patients with pre-existing heart disease? Bottom Line: Intensive statin therapy will decrease overall mortality rates compared with lower doses in patients with a recent history of acute coronary syndrome (ACS) but not in patients with stable coronary heart disease. However, 80 patients must be treated to prevent 1 additional death over 2 years. Intensive treatment decreases overall hospital admissions for heart failure in both groups and decreases major cardiac events in patients with stable coronary heart disease, but, again, the results are not striking. Reference: Afilalo J, Majdan AA, Eisenberg MJ. Intensive statin therapy in acute coronary syndromes and stable coronary heart disease: a comparative meta-analysis of randomised controlled trials. Heart 2007;93(8):914-921. Study Design: Meta-analysis (randomized controlled trials) Funding: Synopsis: Intensive statin therapy reduces major adverse cardiovascular events (MACE), but the effect on mortality is unclear. The researchers determined whether intensive statin therapy reduces all-cause mortality compared with moderate statin therapy in patients with recent acute coronary syndromes (ACS) and stable coronary heart disease (CHD). Medline, Embase, the Cochrane Database, the internet, and conference proceedings from 1966 to 2006 were searched to identify relevant trials. Selection criteria were randomised allocation to intensive statin therapy (atorvastatin 80 mg/day, simvastatin 80 mg/day, or rosuvastatin 20-40 mg/day) versus moderate statin therapy, recent ACS or stable CHD at the time of randomisation, and > or =6 months of follow-up. Six trials, encompassing 110 271 patient-years, were pooled. In patients with recent ACS, intensive statin therapy reduced all-cause mortality from 4.6% to 3.5% over 2.0 years (OR = 0.75, 95% CI 0.61 to 0.93). In patients with stable CHD, intensive statin therapy had no effect on all-cause mortality over 4.7 years (OR = 0.99, 95% CI 0.89 to 1.11). Overall, intensive statin therapy was associated with a reduction in MACE (OR = 0.84, 95% CI 0.77 to 0.91) and admissions to hospital for heart failure (OR = 0.72, 95% CI 0.62 to 0.83). Intensive statin therapy was also associated with an increase in hepatic transaminases >3 times normal (OR = 3.73, 95% CI 2.11 to 6.58) and a trend towards increased creatine kinase >10 times normal and/or rhabdomyolysis (OR = 1.96, 95% CI 0.50 to 7.63).
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I am Certified Family Physician of the Philippine Academy of Family Physician. and continue to complete the requirements for Continuing Medical Education in Family Practice. I am also member of the Philippine Medical Informatics Society, and Pangasinan Medical Society. # College: Fatima College of Medicine (1993) # Post Graduate Internship: National Kidney Institute (1993-1994) # Pass the Physician Board: August (1994) # Post Graduate Course: Occupational Health and Safety, U.P. College of Public Health (1994) # Private Practice since 1994 # Faculty Department of Physiology Lyseum- Northwestern University College of Medicine, Dagupan, Pangasinan, Philippines # Faculty Medical Informatics Lyseum- Northwestern University College of Medicine, Dagupan, Pangasinan, Philippines # Faculty Medical Biochemistry Lyseum- Northwestern University College of Medicine, Dagupan, Pangasinan, Philippines # Member Delta Phi Delta Confraternity # Founding Member Philippine Medical Informatics Society Inc. # Member Physiology Society of the Philippines # President PAFP Pangasinan Chapter, 2006-2008 # Special Skill: 2nd Dan Blackbelt Garciano Kilat Serrada # ECFMG’s Medical School Web Portal (EMSWP) Coordinator # Member WONCA Informatics Working Party # Website: www.randyamy.com , clinicalupdates.randyamy.com
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