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Article: Meta-analysis of large randomized controlled trials to evaluate the impact of statins on cardiovascular outcomes
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TitleMeta-analysis of large randomized controlled trials to evaluate the impact of statins on cardiovascular outcomes
 
AuthorsCheung, BMY1 2
Lauder, IJ1
Lau, CP1
Kumana, CR1
 
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
 
CitationBritish Journal Of Clinical Pharmacology, 2004, v. 57 n. 5, p. 640-651 [How to Cite?]
DOI: http://dx.doi.org/10.1111/j.1365-2125.2003.02060.x
 
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.
 
ISSN0306-5251
2012 Impact Factor: 3.578
2012 SCImago Journal Rankings: 1.150
 
DOIhttp://dx.doi.org/10.1111/j.1365-2125.2003.02060.x
 
PubMed Central IDPMC1884492
 
ISI Accession Number IDWOS:000221169600016
 
ReferencesReferences in Scopus
 
DC FieldValue
dc.contributor.authorCheung, BMY
 
dc.contributor.authorLauder, IJ
 
dc.contributor.authorLau, CP
 
dc.contributor.authorKumana, CR
 
dc.date.accessioned2008-06-12T06:35:00Z
 
dc.date.available2008-06-12T06:35:00Z
 
dc.date.issued2004
 
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.
 
dc.description.naturepublished_or_final_version
 
dc.format.extent388 bytes
 
dc.format.mimetypetext/html
 
dc.identifier.citationBritish Journal Of Clinical Pharmacology, 2004, v. 57 n. 5, p. 640-651 [How to Cite?]
DOI: http://dx.doi.org/10.1111/j.1365-2125.2003.02060.x
 
dc.identifier.doihttp://dx.doi.org/10.1111/j.1365-2125.2003.02060.x
 
dc.identifier.epage651
 
dc.identifier.hkuros86265
 
dc.identifier.isiWOS:000221169600016
 
dc.identifier.issn0306-5251
2012 Impact Factor: 3.578
2012 SCImago Journal Rankings: 1.150
 
dc.identifier.issue5
 
dc.identifier.openurl
 
dc.identifier.pmcidPMC1884492
 
dc.identifier.pmid15089818
 
dc.identifier.scopuseid_2-s2.0-2342468034
 
dc.identifier.spage640
 
dc.identifier.urihttp://hdl.handle.net/10722/49127
 
dc.identifier.volume57
 
dc.languageeng
 
dc.publisherBlackwell Publishing Ltd. The Journal's web site is located at http://www.blackwellpublishing.com/journals/BJCP
 
dc.publisher.placeUnited Kingdom
 
dc.relation.ispartofBritish Journal of Clinical Pharmacology
 
dc.relation.referencesReferences in Scopus
 
dc.rightsBritish Journal of Clinical Pharmacology. Copyright © Blackwell Publishing Ltd.
 
dc.rightsCreative Commons: Attribution 3.0 Hong Kong License
 
dc.rightsThe definitive version is available at www.blackwell-synergy.com
 
dc.subjectCardiovascular disease prevention
 
dc.subjectCoronary heart disease
 
dc.subjectDinical trials
 
dc.subjectHMG-CoA reductase inhibitor
 
dc.subjectLipids
 
dc.subjectMeta-analysis
 
dc.subjectStatin
 
dc.titleMeta-analysis of large randomized controlled trials to evaluate the impact of statins on cardiovascular outcomes
 
dc.typeArticle
 
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Author Affiliations
  1. The University of Hong Kong
  2. Queen Mary Hospital Hong Kong