TY - JOUR T1 - Efficacy of statins for primary prevention in people at low cardiovascular risk: a meta-analysis JF - Canadian Medical Association Journal JO - CMAJ SP - E1189 LP - E1202 DO - 10.1503/cmaj.101280 VL - 183 IS - 16 AU - Marcello Tonelli AU - Anita Lloyd AU - Fiona Clement AU - Jon Conly AU - Don Husereau AU - Brenda Hemmelgarn AU - Scott Klarenbach AU - Finlay A. McAlister AU - Natasha Wiebe AU - Braden Manns Y1 - 2011/11/08 UR - http://www.cmaj.ca/content/183/16/E1189.abstract N2 - Background: 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. Methods: 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. Results: 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. Interpretation: 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. ER -