David J. Maron, MD
Do statins reduce mortality in patients with no history of cardiovascular disease (CVD)?
Included studies compared statins with placebo or control in patients without prevalent CVD at baseline. The outcome was all-cause mortality.
MEDLINE, the Cochrane Library (1970 to May 2009), and reference lists were searched for randomized controlled trials (RCTs). Authors were contacted for additional data as needed. 11 RCTs (n = 65 229, mean age 51 to 75 y, 32% to 100% men) met the selection criteria. 5 trials studied pravastatin (10 to 40 mg/d), 3 used atorvastatin (10 mg/d), and 1 study each used rosuvastatin (20 mg/d), lovastatin (20 to 40 mg/d), and fluvastatin (40 mg/d). 2 trials (n = 4743) recruited patients with diabetes mellitus exclusively. The weighted mean baseline low-density-lipoprotein cholesterol level was 3.57 mmol/L (138 mg/dL).
Meta-analysis showed that statins did not reduce risk for mortality compared with control (Table). Results were similar when 2 RCTs including only patients with diabetes mellitus were excluded (n = 60 486, relative risk reduction 8%, 95% CI −2 to 16).
Statins do not reduce mortality in patients with no history of cardiovascular disease.
Statins vs control for all-cause mortality in high-risk patients with no history of cardiovascular disease*
*Abbreviations defined in Glossary. RRR, NNT, and CI calculated from control event rate and risk ratio in article.
Maron DJ. Review: Statins do not reduce mortality in patients with no history of cardiovascular disease. Ann Intern Med. 2010;153:JC3–4. doi: 10.7326/0003-4819-153-6-201009210-02004
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Published: Ann Intern Med. 2010;153(6):JC3-4.
Cardiology, Coronary Risk Factors, Dyslipidemia.
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