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Statins for the Primary Prevention of Coronary Heart Disease
Min Li1,2, Xiaoli Wang1,2, Xinyi Li1,2
1Key laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China.
Insights
Statins effectively reduce coronary heart disease (CHD) events like angina and myocardial infarction in primary prevention. However, they do not significantly impact CHD or all-cause mortality but may increase diabetes risk.
Area of Science:
- Cardiology
- Preventive Medicine
- Pharmacology
Background:
- Coronary heart disease (CHD) remains a leading cause of mortality worldwide.
- Primary prevention strategies are crucial for reducing the burden of cardiovascular disease.
- Statins are widely prescribed lipid-lowering medications with established cardiovascular benefits.
Purpose of the Study:
- To comprehensively evaluate the efficacy of statins in the primary prevention of coronary heart disease.
- To assess the impact of statins on various CHD-related events and mortality outcomes.
- To identify potential adverse effects associated with statin use in primary prevention.
Main Methods:
- Systematic review and meta-analysis of randomized controlled trials (RCTs).
- Searched six major databases for relevant studies up to October 2017.
- Assessed study quality using GRADE and publication bias using funnel plots and Begg's test.
Main Results:
- Sixteen RCTs involving 69,159 participants were analyzed.
- Statins significantly reduced angina, myocardial infarction (fatal and nonfatal), coronary revascularization, and overall cardiovascular events.
- No significant reduction in CHD deaths or all-cause mortality was observed; however, an increased risk of diabetes was noted.
Conclusions:
- Statins demonstrate significant benefits in reducing the incidence of various coronary heart disease events for primary prevention.
- Current evidence suggests statins do not significantly affect CHD or all-cause mortality.
- Increased risk of developing diabetes is a potential adverse effect of statin therapy in primary prevention.
Object:
The purpose of this study was to fully assess the role of statins in the primary prevention of coronary heart disease (CHD).
Methods:
We searched six databases (PubMed, the Cochrane Library, Web of Science, China National Knowledge Infrastructure, Wanfang Database, and Chinese Scientific Journal Database) to identify relevant randomized controlled trials (RCTs) from inception to 31 October 2017. Two review authors independently assessed the methodological quality and analysed the data using Rev Man 5.3 software. Risk ratios and 95% confidence intervals (95% CI) were pooled using fixed/random-effects models. Funnel plots and Begg's test were conducted to assess publication bias. The quality of the evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.
Results:
Sixteen RCTs with 69159 participants were included in this review. Statins can effectively decrease the occurrence of angina (RR=0.70, 95% CI: 0.58~0.85, I2 =0%), nonfatal myocardial infarction (MI) (RR=0.60, 95% CI: 0.51~0.69, I2 =14%), fatal MI (RR=0.49, 95% CI: 0.24~0.98, I2 =0%), any MI (RR=0.53, 95% CI: 0.42~0.67, I2 =0%), any coronary heart events (RR=0.73, 95% CI: 0.68~0.78, I2=0%), coronary revascularization (RR=0.66, 95% CI: 0.55~0.78, I2 = 0%), and any cardiovascular events (RR=0.77, 95% CI: 0.72~82, I2 = 0%). However, based on the current evidence, there were no significant differences in CHD deaths (RR=0.82, 95% CI: 0.66~1.02, I2=0%) and all-cause mortality (RR=0.88, 95% CI: 0.76 ~1.01, I2 =58%) between the two groups. Additionally, statins were more likely to result in diabetes (RR=1.21, 95% CI: 1.05~1.39, I2 =0%). There was no evidence of publication biases, and the quality of the evidence was considered moderate.
Conclusion:
Statins seemed to be beneficial for the primary prevention of CHDs but have no effect on CHD death and all-cause mortality.
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