Finlay A. McAlister, MD
Are statins effective for primary prevention of cardiovascular (CV) events?
Included studies compared statins with placebo, standard therapy, or no treatment for primary prevention (“> 50% of patients did not have coronary heart disease”); reported CV outcomes; and were ≥ 12 months’ duration. Studies reporting surrogate outcomes (e.g., low- or high-density lipoprotein levels), evaluating cerivastatin, or of high-risk patients with diabetes were excluded. Outcomes included all-cause mortality, CV mortality, fatal myocardial infarction (MI), all MI, stroke, angina, revascularization, and major CV events.
MEDLINE, EMBASE/Excerpta Medica, Cochrane Central, PsycINFO, CINAHL, Web of Science, 4 other databases, reference lists, and health technology assessments were searched to May 2008 for randomized controlled trials (RCTs). 20 RCTs (n = 65 261, mean age range 50 to 75 y, 57% men) met the selection criteria; statins evaluated were atorvastatin (4 RCTs), fluvastatin (3 RCTs), lovastatin (2 RCTs), and pravastatin (11 RCTs).
Meta-analysis showed that compared with placebo, statins reduced all-cause mortality, CV mortality, all MI, fatal MI, stroke, and major CV events in patients with risk factors, including hypertension, hypercholesterolemia, asymptomatic carotid atherosclerosis, and type 2 diabetes without high low-density lipoprotein cholesterol levels (Table). Groups did not differ for angina and revascularization.
Statins are effective for prevention of cardiovascular events in patients without coronary heart disease.
Statins vs placebo, standard therapy, or no treatment (control) for primary prevention of cardiovascular (CV) events*
*MI = myocardial infarction; other abbreviations defined in Glossary. Weighted event rates, RRR, NNT, and CI calculated from control event rates provided by author and relative risks in article using a random-effect model.
†Information provided by author.
‡Calculated from event rates provided by author.
McAlister FA. Review: Statins are effective for prevention of cardiovascular events in patients without coronary heart disease. Ann Intern Med. ;150:JC4–5. doi: 10.7326/0003-4819-150-8-200904210-02005
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Published: Ann Intern Med. 2009;150(8):JC4-5.
Cardiology, Coronary Heart Disease, Coronary Risk Factors, Dyslipidemia, Prevention/Screening.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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