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Statins for Primary Prevention: Homing in on Effectiveness

A new meta-analysis bolsters the case for benefit.

A recent meta-analysis raised doubts about the usefulness of aspirin for the primary prevention of cardiovascular disease (JW Cardiol May 28 2009). To find out whether similar doubts might be raised about statins, investigators conducted a meta-analysis of the randomized trials that included patients without established cardiovascular disease and evaluated subgroups defined by age, sex, and diabetes status.

The investigators identified 10 trials including 70,388 subjects. The mean participant age was 63 years, and the mean follow-up duration was 4.1 years. Two thirds of participants were men, and one fourth had diabetes. The mean baseline LDL level was 140 mg/dL.

Mortality was 5.7% in the control groups and 5.1% in the statin groups (odds ratio, 0.88; 95% confidence interval, 0.81–0.96). A major coronary event occurred in 5.4% of controls and in 4.1% of statin recipients (OR, 0.70; 95% CI, 0.61–0.81). Cerebrovascular events occurred in 2.3% of controls and in 1.9% of statin recipients (OR, 0.81; 95% CI, 0.71–0.93). The effects were consistent in subgroup analyses by age, sex, and diabetes status. Statin use was not associated with an increase in risk for cancer.

Comment: This meta-analysis adds strength to the evidence that statins can reduce the risk for cardiovascular events among patients without established cardiovascular disease. For patients at risk, the key clinical question is whether the magnitude of benefit is worth the cost of treatment. Such decisions are best made by incorporating the patients' preferences.

— Harlan M. Krumholz, MD, SM

Published in Journal Watch Cardiology August 5, 2009

Citation(s):

Brugts JJ et al. The benefits of statins in people without established cardiovascular disease but with cardiovascular risk factors: Meta-analysis of randomised controlled trials. BMJ 2009 Jun 30; 338:b2376. (http://dx.doi.org/10.1136/bmj.b2376)

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