Cited by 772Lipoproteins and Cardiovascular HealthAcute Myocardial Infarction ResearchCancer, Lipids, and Metabolism

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Meta-Analysis of Cardiovascular Outcomes Trials Comparing Intensive Versus Moderate Statin Therapy

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Cannon, Christopher P., Steinberg, Benjamin A., Murphy, Sabina A., Mega, Jessica L., Braunwald, Eugene·2006·Journal of the American College of Cardiology

DOI 10.1016/j.jacc.2006.04.070

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Abstract

Objectives The purpose of this study was to conduct a meta-analysis that compares the reduction of cardiovascular outcomes with high-dose statin therapy versus standard dosing.Background Debate exists regarding the merit of more intensive lipid lowering with high-dose statin therapy as compared with standard-dose therapy.Methods We searched PubMed and article references for randomized controlled trials of intensive versus standard-dose statin therapy enrolling more than 1,000 patients with either stable coronary heart disease or acute coronary syndromes. Four trials were identified: the TNT (Treating to New Targets) and the IDEAL (Incremental Decrease in End Points Through Aggressive Lipid-Lowering) trials involved patients with stable cardiovascular disease, and the PROVE IT-TIMI-22 (Pravastatin or Atorvastatin Evaluation and Infection Therapy-Thrombolysis in Myocardial Infarction-22) and A-to-Z (Aggrastat-to-Zocor) trials involved patients with acute coronary syndromes. We carried out a meta-analysis of the relative odds on the basis of a fixed-effects model using the Mantel-Haenszel method for the major outcomes of death and cardiovascular events.Results A total of 27,548 patients were enrolled in the 4 large trials. The combined analysis yielded a significant 16% odds reduction in coronary death or myocardial infarction (p < 0.00001), as well as a significant 16% odds reduction of coronary death or any cardiovascular event (p < 0.00001). No difference was observed in total or non-cardiovascular mortality, but a trend toward decreased cardiovascular mortality (odds reduction 12%, p = 0.054) was observed.Conclusions Intensive lipid lowering with high-dose statin therapy provides a significant benefit over standard-dose therapy for preventing predominantly non-fatal cardiovascular events.

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Authors: Cannon, C. P., Steinberg, B. A., Murphy, S. A., Mega, J. L., & Braunwald, E.
Affiliations: Brigham and Women's Hospital (US)
Corresponding author: Cannon, Christopher P.
ORCID: Cannon, Christopher P.
Steinberg, Benjamin A.
Murphy, Sabina A.
Mega, Jessica L.
Venue: Journal of the American College of Cardiology
Publisher: Elsevier BV
Published: 2006-08
Volume: 48
Issue: 3
Pages: 438-445
ISSN: 0735-1097 (ISSN-L)
DOI: 10.1016/j.jacc.2006.04.070
OpenAlex: W2040462758
Cited by: 770
References: 27
Citations by year: 2026: 6 · 2025: 13 · 2024: 20 · 2023: 24 · 2022: 22 · 2021: 23 · 2020: 36 · 2019: 26 · 2018: 30 · 2017: 36 · 2016: 35 · 2015: 28 · 2014: 43 · 2013: 46 · 2012: 48
FWCI: 12.90
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/open-access/userlicense/1.0/ (vor, 2541 d)
Locations: Journal of the American College of Cardiology (publishedVersion)
PubMed (publishedVersion)
Funders: Bristol-Myers Squibb
Pfizer
AstraZeneca
GlaxoSmithKline
Sanofi
Topics: Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Lipoproteins and Cardiovascular Health
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Acute Myocardial Infarction Research
Life Sciences › Biochemistry, Genetics and Molecular Biology › Cancer Research › Cancer, Lipids, and Metabolism
Keywords: high-intensity statin therapy, intensive lipid lowering, statin therapy, cardiovascular outcomes, coronary artery disease, acute coronary syndrome, myocardial infarction, coronary death, cardiovascular mortality, TNT trial, IDEAL trial, PROVE IT-TIMI 22, pravastatin, atorvastatin
MeSH terms: Cardiovascular Diseases, Coronary Disease, Dose-Response Relationship, Drug, Humans, Syndrome, Randomized Controlled Trials as Topic, Treatment Outcome, Hydroxymethylglutaryl-CoA Reductase Inhibitors

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Meta-Analysis of Cardiovascular Outcomes Trials Comparing Intensive Versus Moderate Statin Therapy

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