In 2004, Dr. Cannon et al. randomly assigned over 4,162 patients with acute coronary syndrome within past 10 days to either high dose atorvastatin 80 mg or moderate dose 40 mg pravastatin. Their goal was to assess all cause mortality and major cardiovascular events in these patients. Patients who received high dose atorvastatin showed almost 16% absolute reduction in terms of primary outcome (P=0.005) as compared with pravastatin group. These results were similar to the previously performed MIRACL trial that reported similar 16% absolute reduction when atorvastatin was compared with placebo.
The authors concluded that among patients with recent acute coronary syndrome, an intensive lipid-lowering statin therapy provides greater protection against death or major cardiovascular events than does a standard regimen.
The current ESC, as well as ACC/AHA guidelines recommend starting all patients with ACS on high dose statin therapy.