RT Journal Article
SR Electronic
T1 Efficacy of statins for primary prevention in people at low cardiovascular risk: a meta-analysis
JF Canadian Medical Association Journal
JO CMAJ
FD Canadian Medical Association
SP E1189
OP E1202
DO 10.1503/cmaj.101280
VO 183
IS 16
A1 Marcello Tonelli
A1 Anita Lloyd
A1 Fiona Clement
A1 Jon Conly
A1 Don Husereau
A1 Brenda Hemmelgarn
A1 Scott Klarenbach
A1 Finlay A. McAlister
A1 Natasha Wiebe
A1 Braden Manns
YR 2011
UL http://www.cmaj.ca/content/183/16/E1189.abstract
AB 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.