Efficacy of statins for primary prevention in people at low cardiovascular risk: a meta-analysis

Canadian Medical Association Journal, 11/15/2011

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.

Methods

  • Authors searched MEDLINE and EMBASE (to Jan. 28, 2011), registries of health technology assessments and clinical trials, and reference lists of relevant reviews
  • Authors included trials that randomly assigned participants at low cardiovascular risk to receive a statin versus a placebo or no statin
  • Authors defined low risk as an observed 10–year risk of less than 20% for cardiovascular–related death or nonfatal myocardial infarction, but authors explored other definitions in sensitivity analyses.

Results

  • Authors 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.

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