Efficacy of statins for primary prevention in people at low cardiovascular risk: a meta-analysis Full Text
Canadian Medical Association Journal,  Evidence Based Medicine  Clinical Article

Tonelli M et al. – 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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