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Article: Meta-analysis of large randomized controlled trials to evaluate the impact of statins on cardiovascular outcomes

TitleMeta-analysis of large randomized controlled trials to evaluate the impact of statins on cardiovascular outcomes
Authors
KeywordsCardiovascular disease prevention
Coronary heart disease
Dinical trials
HMG-CoA reductase inhibitor
Lipids
Meta-analysis
Statin
Issue Date2004
PublisherBlackwell Publishing Ltd. The Journal's web site is located at http://www.blackwellpublishing.com/journals/BJCP
Citation
British Journal Of Clinical Pharmacology, 2004, v. 57 n. 5, p. 640-651 How to Cite?
Abstract
Aims: Since 2002, there have been five major outcome trials of statins reporting findings from more than 47 000 subjects. As individual trial results differed, we performed a meta-analysis to ascertain the effectiveness and safety of statins overall and in subgroups. The aim of the study was to estimate the effect of statins on major coronary events and strokes, all-cause mortality and noncardiovascular mortality, and in different subgroups. Methods: PubMed was searched for trials published in English. Randomized placebo-controlled statin trials with an average follow up of at least 3 years and at least 100 major coronary events were included. For each trial, the statin used, number and type of subjects, proportion of women, mean age and follow up, baseline and change in lipid profile, cardiovascular and non-cardiovascular outcomes were recorded. Results: Ten trials involving 79 494 subjects were included in the meta-analysis. Due to heterogeneity, ALLHAT-LLT was excluded from some analyses. Statin therapy reduced major coronary events by 27% (95%CI 23, 30%), stroke by 18% (95%CI 10, 25%) and all-cause mortality by 15% (95%CI 8, 21%). There was a 4% (95%CI -10, 3%) nonsignificant reduction in noncardiovascular mortality. The reduction in major coronary events is independent of gender and presence of hypertension or diabetes. The risk reduction was greater in smokers (P < 0.05). Coronary events were reduced by 23% (95%CI 18, 29%) in pravastatin trials and 29% (95%CI 25, 33%) in five trials using other statins. Pravastatin reduced strokes by 12% (95%CI 1, 21%) whilst other statins reduced strokes by 24% (95%CI 16, 32%) (P = 0.04). Conclusions: Statins reduce coronary events, strokes and all-cause mortality without increasing noncoronary mortality. The benefits accrue in men and women, hypertensives and normotensives, diabetics and nondiabetics, and particularly in smokers. Pravastatin appears to have less impact on strokes.
Persistent Identifierhttp://hdl.handle.net/10722/49127
ISSN
2013 Impact Factor: 3.688
PubMed Central ID
ISI Accession Number ID
References

 

Author Affiliations
  1. The University of Hong Kong
  2. Queen Mary Hospital Hong Kong
DC FieldValueLanguage
dc.contributor.authorCheung, BMYen_HK
dc.contributor.authorLauder, IJen_HK
dc.contributor.authorLau, CPen_HK
dc.contributor.authorKumana, CRen_HK
dc.date.accessioned2008-06-12T06:35:00Z-
dc.date.available2008-06-12T06:35:00Z-
dc.date.issued2004en_HK
dc.identifier.citationBritish Journal Of Clinical Pharmacology, 2004, v. 57 n. 5, p. 640-651en_HK
dc.identifier.issn0306-5251en_HK
dc.identifier.urihttp://hdl.handle.net/10722/49127-
dc.description.abstractAims: Since 2002, there have been five major outcome trials of statins reporting findings from more than 47 000 subjects. As individual trial results differed, we performed a meta-analysis to ascertain the effectiveness and safety of statins overall and in subgroups. The aim of the study was to estimate the effect of statins on major coronary events and strokes, all-cause mortality and noncardiovascular mortality, and in different subgroups. Methods: PubMed was searched for trials published in English. Randomized placebo-controlled statin trials with an average follow up of at least 3 years and at least 100 major coronary events were included. For each trial, the statin used, number and type of subjects, proportion of women, mean age and follow up, baseline and change in lipid profile, cardiovascular and non-cardiovascular outcomes were recorded. Results: Ten trials involving 79 494 subjects were included in the meta-analysis. Due to heterogeneity, ALLHAT-LLT was excluded from some analyses. Statin therapy reduced major coronary events by 27% (95%CI 23, 30%), stroke by 18% (95%CI 10, 25%) and all-cause mortality by 15% (95%CI 8, 21%). There was a 4% (95%CI -10, 3%) nonsignificant reduction in noncardiovascular mortality. The reduction in major coronary events is independent of gender and presence of hypertension or diabetes. The risk reduction was greater in smokers (P < 0.05). Coronary events were reduced by 23% (95%CI 18, 29%) in pravastatin trials and 29% (95%CI 25, 33%) in five trials using other statins. Pravastatin reduced strokes by 12% (95%CI 1, 21%) whilst other statins reduced strokes by 24% (95%CI 16, 32%) (P = 0.04). Conclusions: Statins reduce coronary events, strokes and all-cause mortality without increasing noncoronary mortality. The benefits accrue in men and women, hypertensives and normotensives, diabetics and nondiabetics, and particularly in smokers. Pravastatin appears to have less impact on strokes.en_HK
dc.format.extent388 bytes-
dc.format.mimetypetext/html-
dc.languageengen_HK
dc.publisherBlackwell Publishing Ltd. The Journal's web site is located at http://www.blackwellpublishing.com/journals/BJCPen_HK
dc.relation.ispartofBritish Journal of Clinical Pharmacologyen_HK
dc.rightsBritish Journal of Clinical Pharmacology. Copyright © Blackwell Publishing Ltd.en_HK
dc.rightsCreative Commons: Attribution 3.0 Hong Kong License-
dc.rightsThe definitive version is available at www.blackwell-synergy.comen_HK
dc.subjectCardiovascular disease preventionen_HK
dc.subjectCoronary heart diseaseen_HK
dc.subjectDinical trialsen_HK
dc.subjectHMG-CoA reductase inhibitoren_HK
dc.subjectLipidsen_HK
dc.subjectMeta-analysisen_HK
dc.subjectStatinen_HK
dc.titleMeta-analysis of large randomized controlled trials to evaluate the impact of statins on cardiovascular outcomesen_HK
dc.typeArticleen_HK
dc.identifier.openurlhttp://library.hku.hk:4550/resserv?sid=HKU:IR&issn=0306-5251&volume=57&issue=5&spage=640&epage=651&date=2004&atitle=Meta-analysis+of+large+randomized+controlled+trials+to+evaluate+the+impact+of+statins+on+cardiovascular+outcomesen_HK
dc.identifier.emailCheung, BMY:mycheung@hku.hken_HK
dc.identifier.authorityCheung, BMY=rp01321en_HK
dc.description.naturepublished_or_final_versionen_HK
dc.identifier.doi10.1111/j.1365-2125.2003.02060.xen_HK
dc.identifier.pmid15089818en_HK
dc.identifier.pmcidPMC1884492en_HK
dc.identifier.scopuseid_2-s2.0-2342468034en_HK
dc.identifier.hkuros86265-
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-2342468034&selection=ref&src=s&origin=recordpageen_HK
dc.identifier.volume57en_HK
dc.identifier.issue5en_HK
dc.identifier.spage640en_HK
dc.identifier.epage651en_HK
dc.identifier.isiWOS:000221169600016-
dc.publisher.placeUnited Kingdomen_HK
dc.identifier.scopusauthoridCheung, BMY=7103294806en_HK
dc.identifier.scopusauthoridLauder, IJ=35564928000en_HK
dc.identifier.scopusauthoridLau, CP=7401968501en_HK
dc.identifier.scopusauthoridKumana, CR=7005112381en_HK

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