Limited benefit from statins in acute coronary syndrome

Clinical question: 
How effective is early treatment with statins in patients with acute coronary syndrome (ACS)?
Bottom line: 
Compared to placebo or usual care, initiation of statin therapy within 14 days following ACS does not reduce the risk of death, myocardial infarction or stroke within 4 months, but reduces the occurrence of unstable angina at 4 months following ACS. Serious side effects from early treatment with statins were rare (0.1%), and serious muscle toxicity was mostly observed with simvastatin 80mg.
In most of the landmark trials of statins in patients with chronic coronary heart disease (CHD), a benefit of treatment was not evident until 1–2 years after randomisation. Therefore, some of the benefit of statin treatment in the period up to 4 months after ACS may only become manifest after 4 months.
Long-term therapy with statins (for at least 1 year) has been shown to reduce the risk of heart attack, stroke and all-cause mortality in patients with and without established CHD. The early period following ACS is a critical stage of CHD, with a high risk of recurrent events and death. The effects of early treatment with statins in patients suffering from ACS are unclear.
Review CD#: 
September, 2011
Authored by: 
Brian R McAvoy