The benefits of statins in people without established cardiovascular disease but with cardiovascular risk factors: meta-analysis of randomised controlled trials

doi:10.1136/bmj.b2376

Published 30 June 2009, doi:10.1136/bmj.b2376
Cite this as: BMJ 2009;338:b2376

Research

The benefits of statins in people without established cardiovascular disease but with cardiovascular risk factors: meta-analysis of randomised controlled trials

J J Brugts, doctor¹, T Yetgin, doctor¹, S E Hoeks, epidemiologist¹, A M Gotto, professor, doctor², J Shepherd, professor, doctor³, R G J Westendorp, professor, doctor⁴, A J M de Craen, epidemiologist⁴, R H Knopp, professor, doctor⁵, H Nakamura, professor, doctor⁶, P Ridker, professor, doctor⁷, R van Domburg, epidemiologist¹, J W Deckers, doctor¹

¹ Department of Cardiology, Erasmus MC Thoraxcenter, 3015 GD, Rotterdam, Netherlands, ² Weill Medical College of Cornell University, NY, USA, ³ University of Glasgow, Scotland, ⁴ Department of Gerontology and Geriatrics, Leiden University Medical Center, Netherlands, ⁵ Department of Medicine and Northwest Lipid Research Clinic, WA, USA, ⁶ Mitsukoshi Health and Welfare Foundation, Tokyo, Japan, ⁷ Brigham and Women’s Hospital, Boston, MA, USA

Correspondence to: J J Brugts j.brugts{at}erasmusmc.nl

Objectives To investigate whether statins reduce all cause mortalityand major coronary and cerebrovascular events in people withoutestablished cardiovascular disease but with cardiovascular riskfactors, and whether these effects are similar in men and women,in young and older (>65 years) people, and in people withdiabetes mellitus.

Design Meta-analysis of randomised trials.

Data sources Cochrane controlled trials register, Embase, andMedline.

Data abstraction Two independent investigators identified studieson the clinical effects of statins compared with a placebo orcontrol group and with follow-up of at least one year, at least80% or more participants without established cardiovasculardisease, and outcome data on mortality and major cardiovasculardisease events. Heterogeneity was assessed using the Q and I²statistics. Publication bias was assessed by visual examinationof funnel plots and the Egger regression test.

Results 10 trials enrolled a total of 70 388 people, of whom23 681 (34%) were women and 16 078 (23%) had diabetes mellitus.Mean follow-up was 4.1 years. Treatment with statins significantlyreduced the risk of all cause mortality (odds ratio 0.88, 95%confidence interval 0.81 to 0.96), major coronary events (0.70,0.61 to0.81), and major cerebrovascular events (0.81, 0.71 to0.93). No evidence of an increased risk of cancer was observed.There was no significant heterogeneity of the treatment effectin clinical subgroups.

Conclusion In patients without established cardiovascular diseasebut with cardiovascular risk factors, statin use was associatedwith significantly improved survival and large reductions inthe risk of major cardiovascular events.

© Brugts et al 2009
This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Rapid Responses:

Read all Rapid Responses

Did statins have an adverse effect upon outcome in those suffering acute illnesses or trauma?: Richard G Fiddian-Green
bmj.com, 1 Jul 2009 [Full text]
Statin therapy: a need to balance efficacy, safety and healthcare expenditure?: Giuseppe Lippi, et al.
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The benefits are not for all: Enzo Manzato
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What about clinical epidemiology?: Martin Sprenger
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Statins not the only defence: Rosemary A Stanton
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Will this Meta analysis Change Practice?: Muhammad A. Hadi
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Re: Will this Meta analysis Change Practice?: Raymond G Holder
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The pooled estimate of treatment effect could be of different magnitude depending on the level pf risk: oscar mota
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Re: Primary cardiovascular prevention: what role for statins (and for public policy)?: Les O. Simpson
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