Richard A. Davidson, MD, MPH; Eric Rosenberg, MD, MSPH
In adults without established cardiovascular disease (CVD) but with CVD risk factors, do statins reduce mortality?
Selected studies compared statins with control treatment (placebo, active control, or usual care) in adults without established CVD but with CVD risk factors. Primary outcome was all-cause mortality; secondary outcomes included major coronary events (death from coronary heart disease or nonfatal myocardial infarction), major cerebrovascular events (fatal or nonfatal stroke), and cancer.
Cochrane Central Register of Controlled Trials, EMBASE/Excerpta Medica, Database of Abstracts of Reviews of Effects, and ACP Journal Club (to Nov 2008); references; and the “related links” feature in PubMed were searched for randomized controlled trials (RCTs) that had mean follow-up ≥ 1 year and ≥80% of patients without CVD, and reported mortality or CVD events as primary outcomes. 10 RCTs (n = 70 388, mean age 63 y, 66% men, 23% with diabetes) met the selection criteria. Mean follow-up was 4.1 years. 9 RCTs were double-blind, placebo-controlled trials, and all trials scored ≥ 4 on the 5-point Jadad scale for methodological quality.
Statins reduced risk for all-cause mortality and major coronary and cerebrovascular events (Table). No heterogeneity in treatment effect was found for subgroups by sex, age (≤ 65 vs > 65 y), or presence of diabetes. Statins did not increase risk for cancer.
In adults without established cardiovascular disease (CVD) but with CVD risk factors, statins reduce all-cause mortality and major coronary and cerebrovascular events.
Statins vs placebo or usual care (control) in adults*
*Abbreviations defined in Glossary. RRR, NNT, and CI calculated by ACPJC staff from data in article using a random-effects model.
Davidson RA, Rosenberg E. Review: Statins reduce mortality and cardiovascular events in adults at risk for cardiovascular disease. Ann Intern Med. ;151:JC4–14. doi: 10.7326/0003-4819-151-8-200910200-02014
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Published: Ann Intern Med. 2009;151(8):JC4-14.
Cardiology, Coronary Risk Factors, Dyslipidemia, Prevention/Screening.
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