Intensive statin therapy compared with moderate dosing for prevention of cardiovascular events: a meta-analysis of >40 000 patients Full Text
European Heart Journal, 03/16/2011
Evidence Based Medicine
Mills EJ et al. - Available evidence suggests that intensive statin therapy reduces the risk of non-fatal events and may have a role in reducing mortality.Methods
- Comprehensive searches of electronic databases from inception to December 2010 were conducted.
- Any randomized clinical trials (RCTs), evaluating a larger dose with a clinically common dose were included.
- Two reviewers independently extracted data, in duplicate.
- Random-effects meta-analysis and a trial sequential analysis was performed.
- 10 RCTs enrolling a total of 41 778 participants were identified.
- Trials followed patients for a mean of 2.5 years.
- No statistically significant effects on all-cause mortality [relative risk (RR) 0.92, 95% confidence interval (CI), 0.83–1.03, P = 0.14, I2 = 38%] or cardiovascular disease (CVD) deaths (RR 0.89, 95% CI, 0.78–1.01, P = 0.07, I2 = 34%) was found.
- When the composite endpoint of coronary heart disease (CHD) death plus non-fatal myocardial infarction (MI) was pooled, a significant protective effect of intensive statin dosing (RR 0.90, 95% CI, 0.84–0.96, P =< 0.0001, I2 = 0%) was found.
- A subgroup analysis of three trials examining acute coronary syndrome patients found significant effects on all-cause (RR 0.75, 95% CI, 0.61–0.91, P = 0.005, I2 = 0%) and CVD mortality (RR 0.74, 95% CI, 0.59–0.94, P = 0.013, I2 = 0%) with intensive dosing.
- Applying an analysis of optimal information size on the primary analysis, it was found that the evidence for CHD death plus non-fatal MIs is conclusive.
- The evidence for CVD deaths alone is not yet conclusive.