Advertisement
ADVANCED SEARCH

This Article Figures Only Full Text Full Text (PDF) Résumé Online Appendix Submit a response View responses Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Josan, K. Articles by McAlister, F. A. Search for Related Content PubMed PubMed Citation Articles by Josan, K., MD Articles by McAlister, F. A., MD MSc Related Collections Other cardiovascular medicine Drugs: cardiovascular system Related Articles

The efficacy and safety of intensive statin therapy: a meta-analysis of randomized trials

From the Division of General Internal Medicine, Department of Medicine, University of Alberta, Edmonton, Alta.

Correspondence to: Dr. F. McAlister, 2E3.24 Walter C. Mackenzie Health Sciences Centre, University of Alberta Hospital, 8440 112 St., Edmonton AB T6G 2R7; fax 780 407-2680; Finlay.McAlister{at}ualberta.ca

Background: Recent lipid guidelines recommend aggressive low-density lipoprotein (LDL) cholesterol lowering in patients with coronary artery disease. To clarify the evidence for this recommendation, we conducted a meta-analysis of randomized controlled trials that compared different intensities of statin therapy.

Methods: We searched electronic databases (MEDLINE, EMBASE, Cochrane Central Registery of Controlled Trials, Web of Science) for randomized controlled trials published up to July 19, 2007, that compared statin regimens of different intensities in adults with coronary artery disease and that reported cardiovascular events or mortality. Data were pooled using random-effects models to calculate odds ratios (OR).

Results: A total of 7 trials (29 395 patients) were included. Compared with less intensive statin regimens, more intensive regimens further reduced LDL levels (0.72 mmol/L reduction, 95% confidence interval [CI] 0.60–0.84 mmol/L), and reduced the risk of myocardial infarction (OR 0.83, 95% CI 0.77–0.91) and stroke (OR 0.82, 95% CI 0.71–0.95). Although there was no effect on mortality among patients with chronic coronary artery disease (OR 0.96, 95% CI 0.80–1.14), all-cause mortality was reduced among patients with acute coronary syndromes treated with more intensive statin regimens (OR 0.75, 95% CI 0.61–0.93). Compared with lower intensity regimens, more intensive regimens were associated with small absolute increases in rates of drug discontinuation (2.5%), elevated levels of aminotransferases (1%) and myopathy (0.5%), and there was no difference in noncardiovascular mortality. All 7 trials reported events by randomization arm rather than by LDL level achieved. About half of the patients treated with more intensive statin therapy did not achieve an LDL level of less than 2.0 mmol/L, and none of the trials tested combination therapies.

Interpretation: Our analysis supports the use of more intensive statin regimens in patients with established coronary artery disease. There is insufficient evidence to advocate treating to particular LDL targets, using combination lipid-lowering therapy to achieve these targets or for using more intensive regimens in patients without established coronary artery disease.

This article has been cited by other articles:

				F. A. McAlister, M. Fradette, S. R. Majumdar, R. Williams, M. Graham, J. McMeekin, W. A. Ghali, R. T. Tsuyuki, M. L. Knudtson, and J. Grimshaw The Enhancing Secondary Prevention in Coronary Artery Disease trial Can. Med. Assoc. J., December 8, 2009; 181(12): 897 - 904. [Abstract] [Full Text] [PDF]

				M. Sharma, M. T. Ansari, A. M. Abou-Setta, K. Soares-Weiser, T. C. Ooi, M. Sears, F. Yazdi, A. Tsertsvadze, and D. Moher Systematic Review: Comparative Effectiveness and Harms of Combination Therapy and Monotherapy for Dyslipidemia Ann Intern Med, November 3, 2009; 151(9): 622 - 630. [Abstract] [Full Text] [PDF]

				R. P. Morrissey, G. A. Diamond, and S. Kaul Statins in Acute Coronary Syndromes: Do the Guideline Recommendations Match the Evidence? J. Am. Coll. Cardiol., October 6, 2009; 54(15): 1425 - 1433. [Abstract] [Full Text] [PDF]

				M. Sharma, M. T. Ansari, A. M. Abou-Setta, K. Soares-Weiser, T. C. Ooi, M. Sears, F. Yazdi, A. Tsertsvadze, and D. Moher Systematic Review: Comparative Effectiveness and Harms of Combinations of Lipid-Modifying Agents and High-Dose Statin Monotherapy Ann Intern Med, August 31, 2009; (2009) 0000605-200911030-00144v1. [Abstract] [Full Text]

				T. R. Joy and R. A. Hegele Narrative Review: Statin-Related Myopathy Ann Intern Med, June 16, 2009; 150(12): 858 - 868. [Abstract] [Full Text] [PDF]

				A. Rosengren, J. Perk, and J. Dallongeville CHAPTER 12 Prevention of Cardiovascular Disease ESC Textbook of Cardiovascular Medicine, January 1, 2009; 2(1): med-9780199566990-chapter - med-9780199566990-chapter. [Abstract] [Full Text] [PDF]

				F. Crea, P. G. Camici, R. De Caterina, and G. A. Lanza CHAPTER 17 Chronic Ischaemic Heart Disease ESC Textbook of Cardiovascular Medicine, January 1, 2009; 2(1): med-9780199566990-chapter - med-9780199566990-chapter. [Abstract] [Full Text] [PDF]

				Authors/Task Force Members, F. Van de Werf, J. Bax, A. Betriu, C. Blomstrom-Lundqvist, F. Crea, V. Falk, G. Filippatos, K. Fox, K. Huber, et al. Management of acute myocardial infarction in patients presenting with persistent ST-segment elevation: The Task Force on the management of ST-segment elevation acute myocardial infarction of the European Society of Cardiology: Eur. Heart J., December 1, 2008; 29(23): 2909 - 2945. [Full Text] [PDF]

eLetters:

HOME	CURRENT ISSUE	PAST ISSUES	COLLECTIONS	HELP	SEARCH
Copyright 1995-2008, Canadian Medical Association. All rights reserved. ISSN 1488-2329 (e) 0820-3946 (p) All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association.