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Effects of aggressive statin therapy on patients with coronary saphenous vein bypass grafts: a systematic review and meta-analysis of randomized, controlled trials.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Kang, Sheng Liu, Yong Liu, Xue-bo
Description	Country affiliation: China Author Affiliation: Kang S ( Department of Cardiology, Shanghai East hospital, Tongji University, Shanghai, China. kangsheng2008@163.com)
Abstract	OBJECTIVES: The aim of this study was to investigate the effectiveness and safety of aggressive statin versus moderate statin therapy on patients with saphenous vein grafts (SVGs) in randomized, controlled trials (RCTs). METHODS: We searched MEDLINE (1980-June 2012), the Cochrane Controlled Trials Register, EMBASE, Science Citation Index, and PubMed (to June 2012), and found 10 relevant RCTs, including 7 substudy analyses from a Post-CABG trial, and 1 pooled analysis of the PROVE-IT TIMI 22 trial (Pravastatin or Atorvastatin Evaluation and Infection Therapy-Thrombolysis in Myocardial Infarction 22 Investigators) and A to Z trial. Early intensive vs a delayed conservative simvastatin strategy in patients with acute coronary syndromes; phase Z of the A to Z trial. RESULTS: A total of 6645 of participants, ages ranging from 21 to 75 years old, were treated with coronary artery bypass graft (CABG) and were followed for 2 to 5 years. Eight studies showed that aggressive statin therapy had lower LDL-C levels and a decrease of 39% in graft atherosclerotic progression, 12% in new occlusions, and 19% in new lesions more than moderate statin therapy. Three reports indicated that aggressive statin therapy lowered the risk of repeated myocardial infarction more than moderate statin therapy for coronary revascularization (95% CI, 0.66-0.95; risk ratio [RR] = 0.80; and 95% CI, 0.66-0.85; RR = 0.75) and lowered the risk of cardiac death as well (95% CI, 0.64-1.08; RR = 0.83). Aggressive statin therapy had safety similar to that of moderate statin therapy except for a slight increase in myopathic events and aminotransferase levels. Seventy percent to 90% of patients took statin treatment as prescribed in long-term. CONCLUSIONS: Compared with moderate statin therapy, long-term aggressive statin lowered the LDL-C level significantly, further decreased the atherosclerotic progression of SVG, reduced the risks of repeated myocardial infarction and coronary revascularization after CABG, and revealed similar patient compliance and statin-related adverse effects but slightly increased myopathy events and aminotransferase levels.
File Format	HTM / HTML
ISSN	01492918
Issue Number	8
Volume Number	35
e-ISSN	1879114X
Journal	Clinical Therapeutics
Language	English
Publisher	Elsevier
Publisher Date	2013-08-01
Publisher Place	United States
Access Restriction	One Nation One Subscription (ONOS)
Subject Keyword	Discipline Pharmacology Coronary Artery Bypass Coronary Artery Disease Drug Therapy Surgery Hydroxymethylglutaryl-coa Reductase Inhibitors Therapeutic Use Myocardial Infarction Prevention & Control Adult Aged Atorvastatin Calcium Cholesterol, Ldl Blood Female Heptanoic Acids Administration & Dosage Humans Adverse Effects Male Middle Aged Pravastatin Pyrroles Randomized Controlled Trials As Topic Registries Saphenous Vein Simvastatin Treatment Outcome Young Adult Journal Article Meta-analysis Review
Content Type	Text
Resource Type	Article
Subject	Pharmacology Pharmacology (medical)

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