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Efficacy of statins for primary prevention in people at low cardiovascular risk: a meta-analysis

Canadian Medical Association journal (CMAJ), 2011-11, Vol.183 (16), p.E1189-E1202 [Peer Reviewed Journal]

COPYRIGHT 2011 Joule Inc. ;Copyright Canadian Medical Association Nov 8, 2011 ;1995-2011, Canadian Medical Association 2011 ;ISSN: 0820-3946 ;EISSN: 1488-2329 ;DOI: 10.1503/cmaj.101280 ;PMID: 21989464 ;CODEN: CMAJAX

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Title:
Efficacy of statins for primary prevention in people at low cardiovascular risk: a meta-analysis
Author: Tonelli, Marcello ; Lloyd, Anita ; Clement, Fiona ; Conly, Jon ; Husereau, Don ; Hemmelgarn, Brenda ; Klarenbach, Scott ; McAlister, Finlay A ; Wiebe, Natasha ; Manns, Braden
Subjects: Angina, Unstable - epidemiology ; Cardiovascular agents ; Cardiovascular disease ; Cardiovascular diseases ; Cardiovascular Diseases - prevention & control ; Diabetes Mellitus - epidemiology ; Disease prevention ; Dosage and administration ; Drug therapy ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use ; Meta-analysis ; Myocardial Infarction - epidemiology ; Myocardial Revascularization - statistics & numerical data ; Neoplasms - epidemiology ; Patient outcomes ; Prevention ; Primary Prevention ; Randomized Controlled Trials as Topic ; Rhabdomyolysis - epidemiology ; Risk Assessment ; Risk factors ; Statins ; Stroke - epidemiology ; Systematic review
Is Part Of: Canadian Medical Association journal (CMAJ), 2011-11, Vol.183 (16), p.E1189-E1202
Description: Statins were initially used to improve cardiovascular outcomes in people with established coronary artery disease, but recently their use has become more common in people at low cardiovascular risk. We did a systematic review of randomized trials to assess the efficacy and harms of statins in these individuals. We searched MEDLINE and EMBASE (to Jan. 28, 2011), registries of health technology assessments and clinical trials, and reference lists of relevant reviews. We included trials that randomly assigned participants at low cardiovascular risk to receive a statin versus a placebo or no statin. We defined low risk as an observed 10-year risk of less than 20% for cardiovascular-related death or nonfatal myocardial infarction, but we explored other definitions in sensitivity analyses. We identified 29 eligible trials involving a total of 80,711 participants. All-cause mortality was significantly lower among patients receiving a statin than among controls (relative risk [RR] 0.90, 95% confidence interval [CI] 0.84-0.97) for trials with a 10-year risk of cardiovascular disease < 20% [primary analysis] and 0.83, 95% CI 0.73-0.94, for trials with 10-year risk < 10% [sensitivity analysis]). Patients in the statin group were also significantly less likely than controls to have nonfatal myocardial infarction (RR 0.64, 95% CI 0.49-0.84) and nonfatal stroke (RR 0.81, 95% CI 0.68-0.96). Neither metaregression nor stratified analyses suggested statistically significant differences in efficacy between high-and low-potency statins, or larger reductions in cholesterol. Statins were found to be efficacious in preventing death and cardiovascular morbidity in people at low cardiovascular risk. Reductions in relative risk were similar to those seen in patients with a history of coronary artery disease.
Publisher: Canada: Joule Inc
Language: English
Identifier: ISSN: 0820-3946
EISSN: 1488-2329
DOI: 10.1503/cmaj.101280
PMID: 21989464
CODEN: CMAJAX
Source: ProQuest One Psychology
GFMER Free Medical Journals
MEDLINE
PubMed Central
Alma/SFX Local Collection
ProQuest Central
DOAJ Directory of Open Access Journals

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Efficacy of statins for primary prevention in people at low cardiovascular risk: a meta-analysis

COPYRIGHT 2011 Joule Inc. ;Copyright Canadian Medical Association Nov 8, 2011 ;1995-2011, Canadian Medical Association 2011 ;ISSN: 0820-3946 ;EISSN: 1488-2329 ;DOI: 10.1503/cmaj.101280 ;PMID: 21989464 ;CODEN: CMAJAX

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