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Effect of statins on risk of coronary disease: a meta-analysis of randomized controlled trials
J C LaRosa1, J He, S Vupputuri
1Office of the President, State University of New York Health Science Center at Brooklyn, 11203, USA. jclarosa@netmail.hscbklyn.edu
Insights
Statin drug treatment significantly reduces the risk of major coronary events and all-cause mortality. This benefit was observed to be consistent across both men and women, as well as elderly and younger individuals.
Area of Science:
- Cardiovascular Medicine
- Pharmacology
- Epidemiology
Background:
- Lowering low-density lipoprotein cholesterol (LDL-C) is established for reducing recurrent coronary heart disease in middle-aged men.
- The impact of LDL-C reduction on cardiovascular risk in elderly individuals and women remained less certain.
Purpose of the Study:
- To quantify the risk reduction of coronary heart disease and total mortality associated with statin drug treatment.
- To specifically evaluate these effects in elderly populations and women.
Main Methods:
- A meta-analysis was conducted on 5 randomized controlled trials, identified through MEDLINE searches and reference lists, involving 30,817 participants.
- Studies included participants randomized to statin or control treatment for at least 4 years, with clinical disease or death as primary outcomes.
- Data abstraction included sample size, treatment duration, statin type/dosage, baseline characteristics, lipid reduction, and outcomes, with disagreements resolved by consensus.
Main Results:
- Statin treatment led to significant lipid profile improvements: 20% reduction in total cholesterol, 28% in LDL-C, 13% in triglycerides, and a 5% increase in HDL-C.
- Overall, statin use reduced the risk of major coronary events by 31% and all-cause mortality by 21%.
- Crucially, risk reduction for major coronary events was similar in women (29%) and men (31%), and in those aged ≥65 years (32%) versus younger individuals (31%).
Conclusions:
- Reduction in LDL-C through statin therapy effectively lowers the risk of coronary heart disease and all-cause mortality.
- The observed benefits of statin treatment regarding risk reduction are consistent across both sexes and different age groups, including the elderly.
Context:
Lowering low-density lipoprotein cholesterol (LDL-C) is known to reduce risk of recurrent coronary heart disease in middle-aged men. However, this effect has been uncertain in elderly people and women.
Objective:
To estimate the risk reduction of coronary heart disease and total mortality associated with statin drug treatment, particularly in elderly individuals and women.
Data Sources:
Trials published in English-language journals were retrieved by searching MEDLINE (1966-December 1998), bibliographies, and authors' reference files.
Study Selection:
Studies in which participants were randomized to statin or control treatment for at least 4 years and clinical disease or death was the primary outcome were included in the meta-analysis (5 of 182 initially identified).
Data Extraction:
Information on sample size, study drug duration, type and dosage of statin drug, participant characteristics at baseline, reduction in lipids during intervention, and outcomes was abstracted independently by 2 authors (J.H. and S.V.) using a standardized protocol. Disagreements were resolved by consensus.
Data Synthesis:
Data from the 5 trials, with 30 817 participants, were included in this meta-analysis. The mean duration of treatment was 5.4 years. Stati n drug treatment was associated with a20% reduction in total cholesterol, 28% reduction in LDL-C, 13% reduction in triglycerides, and 5% increase in high-density lipoprotein cholesterol. Overall, statin drug treatment reduced risk 31 % in major coronary events (95% confidence interval [CI], 26%-36%) and 21 % in all-cause mortality (95% CI, 14%-28%). The risk reduction in major coronary events was similar between women (29%; 95% Cl, 13 %-42 %) and men (31 %; 95% CI, 26%-35%), and between persons aged at least 65 years (32%; 95% CI, 23%-39%) and persons younger than 65 years (31 %; 95% CI, 24%-36%).
Conclusions:
Our meta-analysis indicates that reduction in LDL-C associated with statin drug treatment decreases the risk of coronary heart disease and all-cause mortality. The risk reduction was similar for men and women and for elderly and middle-aged persons.
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