Meta-Analysis of Cardiovascular Outcomes Trials Comparing Intensive Versus Moderate Statin Therapy
Meta-Analysis of Cardiovascular Outcomes Trials Comparing Intensive Versus Moderate Statin Therapy Christopher P. Cannon, Benjamin A. Steinberg, Sabina A. Murphy, Jessica L. Mega, Eugene Braunwald We conducted a meta-analysis of large, randomized controlled trials of intensive versus standard-dose s...
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| creator | Cannon, Christopher P. Steinberg, Benjamin A. Murphy, Sabina A. Mega, Jessica L. Braunwald, Eugene |
| description | Meta-Analysis of Cardiovascular Outcomes Trials Comparing Intensive Versus Moderate Statin Therapy
Christopher P. Cannon, Benjamin A. Steinberg, Sabina A. Murphy, Jessica L. Mega, Eugene Braunwald
We conducted a meta-analysis of large, randomized controlled trials of intensive versus standard-dose statin therapy with either stable coronary heart disease or acute coronary syndromes. The trials analyzed included TNT (Treating to New Targets), IDEAL (Incremental Decrease in End Points Through Aggressive Lipid-Lowering), PROVE IT–TIMI-22 (Pravastatin or Atorvastatin Evaluation and Infection Therapy–Thrombolysis In Myocardial Infarction-22) and A-to-Z (Aggrastat-to-Zocor). The analysis of 27,548 patients yielded a 16% odds reduction in coronary death or myocardial infarction (p < 0.00001) and a 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 was observed. Thus, intensive lipid lowering with high-dose statin therapy provides a significant benefit over standard-dose therapy for preventing predominantly non-fatal cardiovascular events.
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.
Debate exists regarding the merit of more intensive lipid lowering with high-dose statin therapy as compared with standard-dose therapy.
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.
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 i |
| doi_str_mv | 10.1016/j.jacc.2006.04.070 |
| format | Article |
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Christopher P. Cannon, Benjamin A. Steinberg, Sabina A. Murphy, Jessica L. Mega, Eugene Braunwald
We conducted a meta-analysis of large, randomized controlled trials of intensive versus standard-dose statin therapy with either stable coronary heart disease or acute coronary syndromes. The trials analyzed included TNT (Treating to New Targets), IDEAL (Incremental Decrease in End Points Through Aggressive Lipid-Lowering), PROVE IT–TIMI-22 (Pravastatin or Atorvastatin Evaluation and Infection Therapy–Thrombolysis In Myocardial Infarction-22) and A-to-Z (Aggrastat-to-Zocor). The analysis of 27,548 patients yielded a 16% odds reduction in coronary death or myocardial infarction (p < 0.00001) and a 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 was observed. Thus, intensive lipid lowering with high-dose statin therapy provides a significant benefit over standard-dose therapy for preventing predominantly non-fatal cardiovascular events.
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.
Debate exists regarding the merit of more intensive lipid lowering with high-dose statin therapy as compared with standard-dose therapy.
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.
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.
Intensive lipid lowering with high-dose statin therapy provides a significant benefit over standard-dose therapy for preventing predominantly non-fatal cardiovascular events.</description><identifier>ISSN: 0735-1097</identifier><identifier>EISSN: 1558-3597</identifier><identifier>DOI: 10.1016/j.jacc.2006.04.070</identifier><identifier>PMID: 16875966</identifier><identifier>CODEN: JACCDI</identifier><language>eng</language><publisher>New York, NY: Elsevier Inc</publisher><subject>Biological and medical sciences ; Cardiology ; Cardiology. Vascular system ; Cardiovascular disease ; Cardiovascular Diseases - prevention & control ; Cholesterol ; Coronary Disease - drug therapy ; Dose-Response Relationship, Drug ; Drug therapy ; Heart attacks ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors - administration & dosage ; Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use ; Medical sciences ; Mortality ; Randomized Controlled Trials as Topic ; Statins ; Syndrome ; Treatment Outcome</subject><ispartof>Journal of the American College of Cardiology, 2006-08, Vol.48 (3), p.438-445</ispartof><rights>2006 American College of Cardiology Foundation</rights><rights>2006 INIST-CNRS</rights><rights>Copyright Elsevier Limited Aug 1, 2006</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c556t-90636b9645eff22f382625a7d7c2f2e735b57965f3bf54c8f686616a730decb03</citedby><cites>FETCH-LOGICAL-c556t-90636b9645eff22f382625a7d7c2f2e735b57965f3bf54c8f686616a730decb03</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.jacc.2006.04.070$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=18012975$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/16875966$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Cannon, Christopher P.</creatorcontrib><creatorcontrib>Steinberg, Benjamin A.</creatorcontrib><creatorcontrib>Murphy, Sabina A.</creatorcontrib><creatorcontrib>Mega, Jessica L.</creatorcontrib><creatorcontrib>Braunwald, Eugene</creatorcontrib><title>Meta-Analysis of Cardiovascular Outcomes Trials Comparing Intensive Versus Moderate Statin Therapy</title><title>Journal of the American College of Cardiology</title><addtitle>J Am Coll Cardiol</addtitle><description>Meta-Analysis of Cardiovascular Outcomes Trials Comparing Intensive Versus Moderate Statin Therapy
Christopher P. Cannon, Benjamin A. Steinberg, Sabina A. Murphy, Jessica L. Mega, Eugene Braunwald
We conducted a meta-analysis of large, randomized controlled trials of intensive versus standard-dose statin therapy with either stable coronary heart disease or acute coronary syndromes. The trials analyzed included TNT (Treating to New Targets), IDEAL (Incremental Decrease in End Points Through Aggressive Lipid-Lowering), PROVE IT–TIMI-22 (Pravastatin or Atorvastatin Evaluation and Infection Therapy–Thrombolysis In Myocardial Infarction-22) and A-to-Z (Aggrastat-to-Zocor). The analysis of 27,548 patients yielded a 16% odds reduction in coronary death or myocardial infarction (p < 0.00001) and a 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 was observed. Thus, intensive lipid lowering with high-dose statin therapy provides a significant benefit over standard-dose therapy for preventing predominantly non-fatal cardiovascular events.
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.
Debate exists regarding the merit of more intensive lipid lowering with high-dose statin therapy as compared with standard-dose therapy.
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.
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.
Intensive lipid lowering with high-dose statin therapy provides a significant benefit over standard-dose therapy for preventing predominantly non-fatal cardiovascular events.</description><subject>Biological and medical sciences</subject><subject>Cardiology</subject><subject>Cardiology. Vascular system</subject><subject>Cardiovascular disease</subject><subject>Cardiovascular Diseases - prevention & control</subject><subject>Cholesterol</subject><subject>Coronary Disease - drug therapy</subject><subject>Dose-Response Relationship, Drug</subject><subject>Drug therapy</subject><subject>Heart attacks</subject><subject>Humans</subject><subject>Hydroxymethylglutaryl-CoA Reductase Inhibitors - administration & dosage</subject><subject>Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use</subject><subject>Medical sciences</subject><subject>Mortality</subject><subject>Randomized Controlled Trials as Topic</subject><subject>Statins</subject><subject>Syndrome</subject><subject>Treatment Outcome</subject><issn>0735-1097</issn><issn>1558-3597</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2006</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp90M-L1DAUwPEgijuu_gMeJCDrrTVpm6QFL8vgj4Vd9uDoNaTpi6a0zZiXDsx_b4YZWPDgKQQ-75F8CXnLWckZlx_HcjTWlhVjsmRNyRR7RjZciLaoRaeekw1TtSg469QVeYU4sgxb3r0kV1y2SnRSbkj_AMkUt4uZjuiRBke3Jg4-HAzadTKRPq7JhhmQ7qI3E9JtmPcm-uUXvVsSLOgPQH9CxBXpQxggmgT0ezLJL3T3O1_3x9fkhcuT8OZyXpMfXz7vtt-K-8evd9vb-8IKIVPRMVnLvpONAOeqytVtJSth1KBs5SrIX-mF6qRwde9EY1snWym5NKpmA9ie1dfkw3nvPoY_K2DSs0cL02QWCCvq7Nv8fZ7h-3_gGNaYE6Dmgkmumtwsq-qsbAyIEZzeRz-beNSc6VN_PepTf33qr1mjc_889O6yeu1nGJ5GLsEzuLmAHNhMLprFenxyLeNVp0R2n84OcrGDh6jRelgsDD6CTXoI_n_v-At1bqMW</recordid><startdate>20060801</startdate><enddate>20060801</enddate><creator>Cannon, Christopher P.</creator><creator>Steinberg, Benjamin A.</creator><creator>Murphy, Sabina A.</creator><creator>Mega, Jessica L.</creator><creator>Braunwald, Eugene</creator><general>Elsevier Inc</general><general>Elsevier Science</general><general>Elsevier Limited</general><scope>6I.</scope><scope>AAFTH</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>7TK</scope><scope>H94</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope></search><sort><creationdate>20060801</creationdate><title>Meta-Analysis of Cardiovascular Outcomes Trials Comparing Intensive Versus Moderate Statin Therapy</title><author>Cannon, Christopher P. ; Steinberg, Benjamin A. ; Murphy, Sabina A. ; Mega, Jessica L. ; Braunwald, Eugene</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c556t-90636b9645eff22f382625a7d7c2f2e735b57965f3bf54c8f686616a730decb03</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2006</creationdate><topic>Biological and medical sciences</topic><topic>Cardiology</topic><topic>Cardiology. Vascular system</topic><topic>Cardiovascular disease</topic><topic>Cardiovascular Diseases - prevention & control</topic><topic>Cholesterol</topic><topic>Coronary Disease - drug therapy</topic><topic>Dose-Response Relationship, Drug</topic><topic>Drug therapy</topic><topic>Heart attacks</topic><topic>Humans</topic><topic>Hydroxymethylglutaryl-CoA Reductase Inhibitors - administration & dosage</topic><topic>Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use</topic><topic>Medical sciences</topic><topic>Mortality</topic><topic>Randomized Controlled Trials as Topic</topic><topic>Statins</topic><topic>Syndrome</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Cannon, Christopher P.</creatorcontrib><creatorcontrib>Steinberg, Benjamin A.</creatorcontrib><creatorcontrib>Murphy, Sabina A.</creatorcontrib><creatorcontrib>Mega, Jessica L.</creatorcontrib><creatorcontrib>Braunwald, Eugene</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of the American College of Cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Cannon, Christopher P.</au><au>Steinberg, Benjamin A.</au><au>Murphy, Sabina A.</au><au>Mega, Jessica L.</au><au>Braunwald, Eugene</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Meta-Analysis of Cardiovascular Outcomes Trials Comparing Intensive Versus Moderate Statin Therapy</atitle><jtitle>Journal of the American College of Cardiology</jtitle><addtitle>J Am Coll Cardiol</addtitle><date>2006-08-01</date><risdate>2006</risdate><volume>48</volume><issue>3</issue><spage>438</spage><epage>445</epage><pages>438-445</pages><issn>0735-1097</issn><eissn>1558-3597</eissn><coden>JACCDI</coden><abstract>Meta-Analysis of Cardiovascular Outcomes Trials Comparing Intensive Versus Moderate Statin Therapy
Christopher P. Cannon, Benjamin A. Steinberg, Sabina A. Murphy, Jessica L. Mega, Eugene Braunwald
We conducted a meta-analysis of large, randomized controlled trials of intensive versus standard-dose statin therapy with either stable coronary heart disease or acute coronary syndromes. The trials analyzed included TNT (Treating to New Targets), IDEAL (Incremental Decrease in End Points Through Aggressive Lipid-Lowering), PROVE IT–TIMI-22 (Pravastatin or Atorvastatin Evaluation and Infection Therapy–Thrombolysis In Myocardial Infarction-22) and A-to-Z (Aggrastat-to-Zocor). The analysis of 27,548 patients yielded a 16% odds reduction in coronary death or myocardial infarction (p < 0.00001) and a 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 was observed. Thus, intensive lipid lowering with high-dose statin therapy provides a significant benefit over standard-dose therapy for preventing predominantly non-fatal cardiovascular events.
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.
Debate exists regarding the merit of more intensive lipid lowering with high-dose statin therapy as compared with standard-dose therapy.
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.
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.
Intensive lipid lowering with high-dose statin therapy provides a significant benefit over standard-dose therapy for preventing predominantly non-fatal cardiovascular events.</abstract><cop>New York, NY</cop><pub>Elsevier Inc</pub><pmid>16875966</pmid><doi>10.1016/j.jacc.2006.04.070</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Biological and medical sciences Cardiology Cardiology. Vascular system Cardiovascular disease Cardiovascular Diseases - prevention & control Cholesterol Coronary Disease - drug therapy Dose-Response Relationship, Drug Drug therapy Heart attacks Humans Hydroxymethylglutaryl-CoA Reductase Inhibitors - administration & dosage Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use Medical sciences Mortality Randomized Controlled Trials as Topic Statins Syndrome Treatment Outcome |
| title | Meta-Analysis of Cardiovascular Outcomes Trials Comparing Intensive Versus Moderate Statin Therapy |
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