Higher baseline LDL-C levels amplify the short-term benefit of early intensive statin treatment in acute coronary syndrome

Aim: some randomized studies have shown a delay of up to a few years in the statin-related survival advantage,whereas others have demonstrated an early survival benefit for some patients. we examined the short-term effects of statins in patients with acute coronary syndrome (acs),stratified according to baseline ldl-c. methods: patients with acs (n = 180) were randomized to receive 6 months of atorvastatin (20 mg) in the extended-establish trial. six months after acs onset,all patients were treated with statins to achieve an ldl-c value of < 100 mg/dl. patient outcomes were analyzed with respect to ldl-c at the time of acs onset: high baseline (≥ 100 mg/dl,n = 124) or low baseline (< 100 mg/dl,n = 56) ldl-c. results: the cumulative incidence rates of major adverse cardiac and cerebrovascular events (macce) did not significantly differ between the early-statin and control groups in the high baseline groups at 6 months (p = 0.158),whereas a significant benefit of early intensive statins appeared 1 year (p = 0.034) later. in contrast,we found no significant short-term benefits of statins after either 6 months or 1 year in the low baseline group. multivariate analysis showed that early intensive atorvastatin therapy was associated with a lower risk of macce at 1 year in the high baseline group (or,0.25; 95% ci,0.05 to 0.83; p = 0.035). conclusions: the effects of 6 months of intensive lipid-lowering therapy appear after 1 year in patients with acs and baseline ldl-c ≥ 100 mg/dl.