Effect of lipid-lowering therapy on early mortality after acute coronary syndromes: an observational study

Lancet. 2001 Apr 7;357(9262):1063-8. doi: 10.1016/S0140-6736(00)04257-4.


Background: Lipid-lowering agents are known to reduce long-term mortality in patients with stable coronary disease or significant risk factors. However, the effect of lipid-lowering therapy on short-term mortality immediately after an acute coronary syndrome has not been determined. We did an observational study using data from two randomised trials to investigate this issue.

Methods: We used data from the GUSTO IIb and PURSUIT trials to compare all-cause mortality among patients with acute coronary syndromes who were discharged on lipid-lowering agents (n=3653) with those who were not (n=17,156). A propensity analysis was done to adjust for presumed selection biases in the prescription of lipid-lowering agents.

Findings: Lipid-lowering therapy was associated with a smaller proportion of deaths at 30 days (17 [0.5%] vs 179 [1.0%], hazard ratio 0.44 [95% CI 0.27-0.73], p=0.001) and at 6 months (63 [1.7%] vs 605 [3.5%], 0.48 [0.37-0.63], p<0.0001). After adjustment for the propensity to be prescribed lipid-lowering agents and other potential confounders, prescription of a lipid-lowering agent at discharge remained associated with a reduced risk of death at 6 months (0.67 [0.48-0.95], p=0.023).

Interpretation: Prescription of a lipid-lowering drug at hospital discharge was independently associated with reduced short-term mortality among patients after an acute coronary syndrome.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Disease
  • Aged
  • Angina, Unstable / complications
  • Angina, Unstable / drug therapy
  • Angina, Unstable / mortality*
  • Female
  • Humans
  • Hyperlipidemias / complications
  • Hypolipidemic Agents / therapeutic use*
  • Logistic Models
  • Male
  • Middle Aged
  • Myocardial Infarction / complications
  • Myocardial Infarction / drug therapy
  • Myocardial Infarction / mortality*
  • Randomized Controlled Trials as Topic
  • Survival Rate
  • Thrombolytic Therapy


  • Hypolipidemic Agents