OBJECTIVES: To examine if intensive statin therapy benefits demonstrated in randomized clinical trials (RCTs) could be substantiated in managed care patients hospitalized for cardiovascular events and procedures (CVEP). METHODS: An integrated US medical/pharmacy claims database (43 million members) was used to examine patient mortality risk following hospitalization discharge for CVEP (nonfatal MI, resuscitated cardiac arrest, acute coronary occlusion, CABG or PTCA). Inclusion criteria: age 18 years, health plan enrollment >12 months prior to and > 1 month after hospitalization, and index hospitalization for CVEP between January 2000 to June 2003. Patients were identified as receiving no statin therapy within 30 days after discharge (S-), or receiving statin therapy. Statin therapy was defined as standard (STD) or intensive (INT), RESULTS: Among matched pairs, crude death rates were 3.26% vs. 5.21% for INT vs. S- (n=1,688 matched pairs); 4.39% vs. 5.75% for STD vs. S- (n=2346 matched pairs); and 2.33% vs. 3.26% for INT vs. STD (n=3,342 matched pairs). In Cox Proportional hazards models, risk of death was lower among patients treated with INT and STD therapy vs. S- (INT vs. S- Hazard Ratio [HR]=0.581, 95% CI=0.414, 0.816, p=.0017; STD vs. S- HR=0.677, 95% CI=0.525, 0.872, p=.0026). Patients receiving INT had 30% lower risk of death compared to STD (HR=0.707, 95% CI = 0.528, 0.947; p=.0200). CONCLUSIONS: This real-world study validates benefits of intensive statin therapy reported in recent RCTs, and clinically significant reductions in mortality following cardiovascular hospitalization.