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.