Statins and all-cause mortality in high-risk primary prevention
While statins may be of limited to no benefit in individuals considered to be at comparatively high risk for CVD, tried and proven nonpharmacologic approaches to the primary prevention of CVD remain available...
Title: Statins and all-cause mortality in high-risk primary prevention: A meta-analysis of 11 randomized controlled trials involving 65,229 participants
Authors: K Ray, S Seshasai, S Erquo, P Server, et al.
Reference: Arch Intern Med 2010; 170:1024-1031
http://archinte.ama-assn.org/cgi/content/short/170/12/1024
Reviewer: Robert Goldberg, PhD, Contributing editor, ProCor; Professor of Medicine and Epidemiology, Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA
Reviewer comments: Statin therapy has been shown to be an extremely effective modality for reducing higher than optimal serum lipid levels in both healthy individuals and in those with underlying cardiovascular disease (CVD). These drugs are commonly used for the prevention and treatment of CVD and the statins have been shown to have a multiplicity of beneficial effects on various pathophysiologic processes that may lead to the development of different chronic diseases.
While statin therapy has been shown to be effective in improving the long-term outlook and prognosis of persons with CHD, there is a relative paucity of data to support the use of this treatment modality in persons without prior CHD, irrespective of their level of risk.
The results of the present well-done meta analysis in persons deemed to be at intermediate to high risk for CHD suggest that statin therapy was not associated with a statistically significant reduction in all-cause mortality in persons randomly assigned to take statin therapy as compared to those not so. On the other hand, use of this medication was associated with an average decline of 9% in total mortality (with upwards of a 17% decline to a 1% increase in all-cause death rates). These findings were based on data from more than 65,000 men and women who were enrolled in 11 RCT's in whom nearly 3000 deaths occurred over an average follow-up of nearly four years. These findings suggest that while statins may be of limited to no benefit in individuals considered to be at comparatively high risk for CVD, tried and proven nonpharmacologic approaches to the primary prevention of CVD remain available including smoking cessation, increasing one's level of regular and vigorous physical activity, maintenance of ideal body weight, careful attention to one's total caloric, fat, and salt intake, and stress reduction.
Purpose of study: To perform a meta-analysis of published randomized trials that have examined the association between receipt of statin therapy and all-cause mortality among persons considered to be at intermediate to high risk for CVD.
Location of study: Cambridge, England
Study design: Meta analysis
Results: The authors carried out an extensive search of the published literature (1970-2009) for purposes of identifying randomized controlled trials (RCTs) of statin therapy that collected information on total mortality and excluded individuals with CVD at the time of baseline enrollment.
A total of 11 trials were identified, which satisfied the investigator's inclusion criteria, and more than 65,000 men and women were included in these RCTs. The average age of trial participants ranged from ages 51-75 years and the proportion of women included ranged from none to approximately two-thirds. The average baseline levels of serum LDL cholesterol across the pooled studies were 138 mg/dl.
In this study population, a total of 2793 individuals died who contributed approximately 244,000 person years of follow-up. All-cause death rates ranged from 3.6 to 26.0 (per 1000 person years) in individuals assigned to the placebo/control arms across the published trials and from 2.4 to 27.2 (per 1000 person years) in the statin treated groups. In these trials, 1447 deaths occurred among 32,606 participants who were randomly assigned to the placebo/control groups compared to 1346 deaths in persons randomly allocated to the statin treated arms.
The risk ratio for all-cause mortality in association with the use of statins was 0.91 (95% CI 0.83, 1.01). There was no statistically significant relationship between reduction in average LDL-cholesterol levels and total mortality.
Title: Statins and all-cause mortality in high-risk primary prevention: A meta-analysis of 11 randomized controlled trials involving 65,229 participants
Authors: K Ray, S Seshasai, S Erquo, P Server, et al.
Reference: Arch Intern Med 2010; 170:1024-1031
http://archinte.ama-assn.org/cgi/content/short/170/12/1024
Reviewer: Robert Goldberg, PhD, Contributing editor, ProCor; Professor of Medicine and Epidemiology, Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA
Reviewer comments: Statin therapy has been shown to be an extremely effective modality for reducing higher than optimal serum lipid levels in both healthy individuals and in those with underlying cardiovascular disease (CVD). These drugs are commonly used for the prevention and treatment of CVD and the statins have been shown to have a multiplicity of beneficial effects on various pathophysiologic processes that may lead to the development of different chronic diseases.
While statin therapy has been shown to be effective in improving the long-term outlook and prognosis of persons with CHD, there is a relative paucity of data to support the use of this treatment modality in persons without prior CHD, irrespective of their level of risk.
The results of the present well-done meta analysis in persons deemed to be at intermediate to high risk for CHD suggest that statin therapy was not associated with a statistically significant reduction in all-cause mortality in persons randomly assigned to take statin therapy as compared to those not so. On the other hand, use of this medication was associated with an average decline of 9% in total mortality (with upwards of a 17% decline to a 1% increase in all-cause death rates). These findings were based on data from more than 65,000 men and women who were enrolled in 11 RCT's in whom nearly 3000 deaths occurred over an average follow-up of nearly four years. These findings suggest that while statins may be of limited to no benefit in individuals considered to be at comparatively high risk for CVD, tried and proven nonpharmacologic approaches to the primary prevention of CVD remain available including smoking cessation, increasing one's level of regular and vigorous physical activity, maintenance of ideal body weight, careful attention to one's total caloric, fat, and salt intake, and stress reduction.
Purpose of study: To perform a meta-analysis of published randomized trials that have examined the association between receipt of statin therapy and all-cause mortality among persons considered to be at intermediate to high risk for CVD.
Location of study: Cambridge, England
Study design: Meta analysis
Results: The authors carried out an extensive search of the published literature (1970-2009) for purposes of identifying randomized controlled trials (RCTs) of statin therapy that collected information on total mortality and excluded individuals with CVD at the time of baseline enrollment.
A total of 11 trials were identified, which satisfied the investigator's inclusion criteria, and more than 65,000 men and women were included in these RCTs. The average age of trial participants ranged from ages 51-75 years and the proportion of women included ranged from none to approximately two-thirds. The average baseline levels of serum LDL cholesterol across the pooled studies were 138 mg/dl.
In this study population, a total of 2793 individuals died who contributed approximately 244,000 person years of follow-up. All-cause death rates ranged from 3.6 to 26.0 (per 1000 person years) in individuals assigned to the placebo/control arms across the published trials and from 2.4 to 27.2 (per 1000 person years) in the statin treated groups. In these trials, 1447 deaths occurred among 32,606 participants who were randomly assigned to the placebo/control groups compared to 1346 deaths in persons randomly allocated to the statin treated arms.
The risk ratio for all-cause mortality in association with the use of statins was 0.91 (95% CI 0.83, 1.01). There was no statistically significant relationship between reduction in average LDL-cholesterol levels and total mortality.
Reply to this message
© 2010 ProCor | Privacy Policy