Ray KK, Seshasai SRK Erqou S, et al. Statins and All-Cause Mortality in High-Risk Primary Prevention: A Meta-analysis of 11 Randomized Controlled Trials Involving 65 229 Participants. Arch Intern Med 2010 Jun 28;170(12):1024-1031. (Review; Meta-analysis)
http://archinte.ama-assn.org/cgi/content/full/170/12/1024
http://archinte.ama-assn.org/cgi/content/full/170/12/1024
http://archinte.ama-assn.org/cgi/reprint/170/12/1024.pdf
++++
related:
de Lorgeril M, Salen P, Abramson J, et al. Cholesterol Lowering, Cardiovascular Diseases, and the Rosuvastatin-JUPITER Controversy: A Critical Reappraisal. Arch Intern Med 2010 Jun 28;170(12):1032-1036.
+++++
editorial:
Green LA. Cholesterol-Lowering Therapy for Primary Prevention: Still Much We Don't Know. Arch Intern Med 2010 Jun 28;170(12):1007-1008. (Editorial)
http://archinte.ama-assn.org/cgi/content/full/170/12/1007
http://archinte.ama-assn.org/cgi/reprint/170/12/1007.pdf
Kaul S, Morrissey RP, Diamond GA. By Jove! What Is a Clinician to Make of JUPITER? Arch Intern Med 2010 Jun 28;170(12):1073-1077. (Editorial)
http://archinte.ama-assn.org/cgi/content/full/170/12/1073
http://archinte.ama-assn.org/cgi/reprint/170/12/1073.pdf
key info
This literature-based meta-analysis did not find evidence for the benefit of statin therapy on all-cause mortality in a high-risk primary prevention set-up.
++++
Vol. 170 No. 12, June 28, 2010
Archives
Review Article
Statins and All-Cause Mortality in High-Risk Primary Prevention
A Meta-analysis of 11 Randomized Controlled Trials Involving 65 229 Participants
Kausik K. Ray, MD, MPhil, FACC, FESC; Sreenivasa Rao Kondapally Seshasai, MD, MPhil; Sebhat Erqou, MD, MPhil, PhD; Peter Sever, PhD, FRCP, FESC; J. Wouter Jukema, MD, PhD; Ian Ford, PhD; Naveed Sattar, FRCPath
Arch Intern Med. 2010;170(12):1024-1031.
ABSTRACT
Background Statins have been shown to reduce the risk of all-cause mortality among individuals with clinical history of coronary heart disease. However, it remains uncertain whether statins have similar mortality benefit in a high-risk primary prevention setting. Notably, all systematic reviews to date included trials that in part incorporated participants with prior cardiovascular disease (CVD) at baseline. Our objective was to reliably determine if statin therapy reduces all-cause mortality among intermediate to high-risk individuals without a history of CVD.
Data Sources Trials were identified through computerized literature searches of MEDLINE and Cochrane databases (January 1970-May 2009) using terms related to statins, clinical trials, and cardiovascular end points and through bibliographies of retrieved studies.
Study Selection Prospective, randomized controlled trials of statin therapy performed in individuals free from CVD at baseline and that reported details, or could supply data, on all-cause mortality.
Data Extraction Relevant data including the number of patients randomized, mean duration of follow-up, and the number of incident deaths were obtained from the principal publication or by correspondence with the investigators.
Data Synthesis Data were combined from 11 studies and effect estimates were pooled using a random-effects model meta-analysis, with heterogeneity assessed with the I2 statistic. Data were available on 65 229 participants followed for approximately 244 000 person-years, during which 2793 deaths occurred. The use of statins in this high-risk primary prevention setting was not associated with a statistically significant reduction (risk ratio, 0.91; 95% confidence interval, 0.83-1.01) in the risk of all-cause mortality. There was no statistical evidence of heterogeneity among studies (I2 = 23%; 95% confidence interval, 0%-61% [P = .23]).
Conclusion This literature-based meta-analysis did not find evidence for the benefit of statin therapy on all-cause mortality in a high-risk primary prevention set-up.
© 2010 American Medical Association.