TY - JOUR
T1 - The effects of lowering LDL cholesterol with statin therapy in people at low risk of vascular disease: meta-analysis of individual data from 27 randomised trials
AU - Mihaylova, B.
AU - Emberson, J.
AU - Blackwell, L.
AU - Keech, A.
AU - Simes, J.
AU - Barnes, E. H.
AU - Voysey, M.
AU - Gray, A.
AU - Collins, R.
AU - Baigent, C.
AU - de Lemos, J.
AU - Braunwald, E.
AU - Blazing, M.
AU - Murphy, S.
AU - Downs, J. R.
AU - Gotto, A.
AU - Clearfield, M.
AU - Holdaas, H.
AU - Gordon, D.
AU - Davis, B.
AU - Koren, M.
AU - Dahlof, B.
AU - Poulter, N.
AU - Sever, P.
AU - Knopp, R. H.
AU - Fellstrom, B.
AU - Jardine, A.
AU - Schmieder, R.
AU - Zannad, F.
AU - Goldbourt, U.
AU - Kaplinsky, E.
AU - Colhoun, H. M.
AU - Betteridge, D. J.
AU - Durrington, P. N.
AU - Hitman, G. A.
AU - Fuller, J.
AU - Neil, A.
AU - Wanner, C.
AU - Krane, V.
AU - Sacks, F.
AU - Moye, L.
AU - Pfeffer, M.
AU - Hawkins, C. M.
AU - Kjekshus, J.
AU - Wedel, H.
AU - Wikstrand, J.
AU - Barter, P.
AU - Tavazzi, L.
AU - Maggioni, A.
AU - Marchioli, R.
AU - Cholesterol Treatment Trialists
PY - 2012
Y1 - 2012
N2 - Background Statins reduce LDL cholesterol and prevent vascular events, but their net effects in people at low risk of vascular events remain uncertain.Methods This meta-analysis included individual participant data from 22 trials of statin versus control (n=134 537; mean LDL cholesterol difference 1.08 mmol/L; median follow-up 4.8 years) and five trials of more versus less statin (n=39 612; difference 0.51 mmol/L; 5.1 years). Major vascular events were major coronary events (ie,non-fatal myocardial infarction or coronary death), strokes, or coronary revascularisations. Participants were separated into five categories of baseline 5-year major vascular event risk on control therapy (no statin or low-intensity statin) (= 5% to = 10% to = 20% to = 30%); in each, the rate ratio (RR) per 1.0 mmol/L LDL cholesterol reduction was estimated.Findings Reduction of LDL cholesterol with a statin reduced the risk of major vascular events (RR 0.79, 95% CI 0.77-0.81, per 1.0 mmol/L reduction), largely irrespective of age, sex, baseline LDL cholesterol or previous vascular disease, and of vascular and all-cause mortality. The proportional reduction in major vascular events was at least as big in the two lowest risk categories as in the higher risk categories (RR per 1.0 mmol/L reduction from lowest to highest risk: 0.62 [99% CI 0.47-0.81], 0.69 [99% CI 0.60-0.79], 0.79 [99% CI 0.74-0.85], 0.81 [99% CI 0.77-0.86], and 0.79 [99% CI 0.74-0.84]; trend p=0.04), which reflected significant reductions in these two lowest risk categories in major coronary events (RR 0.57, 99% CI 0.36-0.89, p=0.0012, and 0.61, 99% CI 0.50-0.74, pInterpretation In individuals with 5-year risk of major vascular events lower than 10%, each 1 mmol/L reduction in LDL cholesterol produced an absolute reduction in major vascular events of about 11 per 1000 over 5 years. This benefit greatly exceeds any known hazards of statin therapy. Under present guidelines, such individuals would not typically be regarded as suitable for LDL-lowering statin therapy. The present report suggests, therefore, that these guidelines might need to be reconsidered.
AB - Background Statins reduce LDL cholesterol and prevent vascular events, but their net effects in people at low risk of vascular events remain uncertain.Methods This meta-analysis included individual participant data from 22 trials of statin versus control (n=134 537; mean LDL cholesterol difference 1.08 mmol/L; median follow-up 4.8 years) and five trials of more versus less statin (n=39 612; difference 0.51 mmol/L; 5.1 years). Major vascular events were major coronary events (ie,non-fatal myocardial infarction or coronary death), strokes, or coronary revascularisations. Participants were separated into five categories of baseline 5-year major vascular event risk on control therapy (no statin or low-intensity statin) (= 5% to = 10% to = 20% to = 30%); in each, the rate ratio (RR) per 1.0 mmol/L LDL cholesterol reduction was estimated.Findings Reduction of LDL cholesterol with a statin reduced the risk of major vascular events (RR 0.79, 95% CI 0.77-0.81, per 1.0 mmol/L reduction), largely irrespective of age, sex, baseline LDL cholesterol or previous vascular disease, and of vascular and all-cause mortality. The proportional reduction in major vascular events was at least as big in the two lowest risk categories as in the higher risk categories (RR per 1.0 mmol/L reduction from lowest to highest risk: 0.62 [99% CI 0.47-0.81], 0.69 [99% CI 0.60-0.79], 0.79 [99% CI 0.74-0.85], 0.81 [99% CI 0.77-0.86], and 0.79 [99% CI 0.74-0.84]; trend p=0.04), which reflected significant reductions in these two lowest risk categories in major coronary events (RR 0.57, 99% CI 0.36-0.89, p=0.0012, and 0.61, 99% CI 0.50-0.74, pInterpretation In individuals with 5-year risk of major vascular events lower than 10%, each 1 mmol/L reduction in LDL cholesterol produced an absolute reduction in major vascular events of about 11 per 1000 over 5 years. This benefit greatly exceeds any known hazards of statin therapy. Under present guidelines, such individuals would not typically be regarded as suitable for LDL-lowering statin therapy. The present report suggests, therefore, that these guidelines might need to be reconsidered.
KW - MYOCARDIAL-INFARCTION
KW - FOLLOW-UP
KW - SCANDINAVIAN SIMVASTATIN SURVIVAL
KW - PLACEBO-CONTROLLED TRIAL
KW - CARDIOVASCULAR-DISEASE
KW - PRIMARY PREVENTION
KW - DIABETES-MELLITUS
KW - HIGH-DOSE ATORVASTATIN
KW - TREATMENT PANEL-III
KW - CORONARY-HEART-DISEASE
U2 - 10.1016/S0140-6736(12)60367-5
DO - 10.1016/S0140-6736(12)60367-5
M3 - Article
SN - 0140-6736
VL - 380
SP - 581
EP - 590
JO - Lancet
JF - Lancet
IS - 9841
ER -
