- Question
- Is intensive statin therapy superior to standard statin therapy for reducing death and major cardiovascular events in patients after an acute coronary syndrome?
- Design
- Randomized trial comparing two statin regimens in 4162 patients, designed to establish the noninferiority of pravastatin versus atorvastatin for time to an end-point event. Follow-up lasted 18 to 36 months (mean 24).
- Population
- Patients hospitalized for an acute coronary syndrome within the preceding 10 days.
- Intervention
- Atorvastatin 80 mg daily (intensive therapy).
- Control
- Pravastatin 40 mg daily (standard therapy).
- Primary outcome
- Composite of death from any cause, myocardial infarction, documented unstable angina requiring rehospitalization, revascularization (performed at least 30 days after randomization), and stroke.
- Results
- At two years, primary end point rates were 26.3% with pravastatin and 22.4% with atorvastatin, a 16% reduction in the hazard ratio favoring atorvastatin (P=0.005; 95% CI, 5 to 26%). Median achieved LDL cholesterol was 95 mg/dL with pravastatin and 62 mg/dL with atorvastatin (P<0.001).
- Conclusion
- In patients with a recent acute coronary syndrome, an intensive statin regimen provides greater protection against death or major cardiovascular events than a standard regimen.
- Why it matters
- It supported early, sustained LDL cholesterol lowering to levels substantially below the targets of the time in these patients, driving the adoption of high-intensity statin therapy after an acute coronary syndrome.
Card generated automatically with AI from the abstract of the original publication and the trial registry; every figure was checked against those sources. It may contain errors: verify the data at the source before using it for clinical decisions.
Generated on October 10, 2026