Annals of Medicine (Dec 2024)

Benefits of intensive lipid-lowering therapies in patients with acute coronary syndrome: a systematic review and meta-analysis

  • Xian-Dan Wu,
  • Xin-Yue Ye,
  • Xuan-Yan Liu,
  • Yue Lin,
  • Xian Lin,
  • Yan-Yan Li,
  • Bin-Hua Ye,
  • Jing-Chao Sun

DOI
https://doi.org/10.1080/07853890.2024.2389470
Journal volume & issue
Vol. 56, no. 1

Abstract

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Background Previous meta-analyses have investigated the efficacy of lipid-lowering therapies for atherosclerotic cardiovascular disease; however, few have focused on patients with acute coronary syndrome (ACS). This meta-analysis aimed to compare the benefits of intensive lipid-lowering therapy with those of background statin therapy in patients with ACS.Methods Searches were performed on PubMed, Embase, the Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov databases for articles published until April 13, 2023. Randomized controlled trials that compared intensive lipid-lowering therapies and background statin therapies in patients with prior ACS and recorded the outcome of three-point major cardiovascular events (MACE) were included. The risk ratio (RR) with 95% confidence interval (CI) was used as a measure of primary and secondary outcomes.Results Nine trials involving 38,640 patients with ACS were identified. Pooled results suggested that intensive lipid-lowering therapies are associated with a reduction in the risk of three-point MACE (RR, 0.88; 95% CI, 0.83–0.94; p < 0.001), recurrent ACS (RR, 0.82; 95% CI, 0.71–0.96; p = 0.013), nonfatal myocardial infarction (MI) (RR, 0.87; 95% CI, 0.81–0.93; p < 0.001), stroke (RR, 0.83; 95% CI, 0.73–0.94; p = 0.003), and unstable angina-related hospitalization (RR, 0.57; 95% CI, 0.33–0.99; p = 0.046), but not all-cause mortality (RR, 0.94; 95% CI, 0.82–1.07; p = 0.329), cardiovascular disease-related mortality (RR, 0.96; 95% CI, 0.88–1.06; p = 0.457) or coronary revascularization (RR, 0.89; 95% CI, 0.79–1.00; p = 0.057).Conclusions Intensive lipid-lowering therapies may reduce the risk of three-point MACE, recurrent ACS, nonfatal MI, stroke, and hospitalization for unstable angina in patients with ACS undergoing background statin therapy. These results may assist in clinical decision-making for the secondary prevention of cardiovascular events to initiate intensive lipid-lowering therapies immediately after ACS.

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