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
2011 Impact Factor: 2.958
2011 SCImago Journal Rankings: 0.231
DOIhttp://dx.doi.org/10.1111/j.1365-2125.2003.02060.x
ISI Accession Number IDWOS:000221169600016
PubMed Central IDPMC1884492
ReferencesReferences in Scopus
DC Field
Value
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
2011 Impact Factor: 2.958
2011 SCImago Journal Rankings: 0.231
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
Author Affiliations
  1. The University of Hong Kong
  2. Queen Mary Hospital Hong Kong