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Statins for Primary Prevention of Cardiovascular Disease

Statin users were less likely to experience major adverse coronary or cerebrovascular events.

Statins clearly confer substantial benefit in people with established cardiovascular (CV) disease (secondary prevention); however, the magnitude of benefit in people without CV disease (primary prevention) is less clear. In this meta-analysis of 10 randomized controlled trials that involved 70,000 patients, investigators assessed the effects of statins in people without CV disease but with CV risk factors.

Participants (mean age, 63; 34% women) were followed for an average of 4.1 years. Compared with participants in the statin group, significantly more participants in the control group died (5.1% vs. 5.7%; odds ratio, 0.88), had major adverse coronary events (4.1% vs. 5.4%; OR, 0.70), or had major adverse cerebrovascular events (1.9% vs. 2.3%; OR, 0.81). Also, no significant differences in treatment benefits were noted between men and women, younger and older participants, and those with and without diabetes. Notably, statin use was not associated with excess risk for cancer.

Comment: In this meta-analysis, statins significantly lowered risks for death, major adverse coronary events, and major adverse cerebrovascular events in patients without established CV disease but with CV risk factors. These results, however, should be interpreted with caution: Whereas the relative risk reductions are impressive, the absolute risk reductions are small. The authors acknowledge that "the absolute treatment benefit . . . would certainly be less than 1%, and significant numbers" of patients (i.e., 100) would need to be treated for 4 years to prevent 1 adverse CV event.

— Paul S. Mueller, MD, MPH, FACP

Published in Journal Watch General Medicine July 16, 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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• Statins
  J L Brown, 17 Jul 2009 3:17 PM EST
  I am not surprised, considering the mechanism of action. Why should we not give statins to everyone over a certain... [more]
• Number Needed to treat!
  Ajay Kumar Khandal, 17 Jul 2009 3:17 PM EST
  When we talk about statistics, it need to address, what is called as a number needed to treat, and more... [more]
• statins
  Doug A Kaufmann, 20 Jul 2009 1:59 PM EST
  A.V. Costantini, MD with WHO stated that prior to being used for hyperlipidemia, statin drugs were antifungal drugs. If this... [more]
• Statins and Aspirin - all about baseline risk
  Andrew D. Calvin, Mayo Clinic, 21 Jul 2009 10:39 AM EST
  Just like the debate about aspirin, we apparently need to consider baseline risk to put the sometimes impressive-sounding relative risk... [more]