Statins for Prevention of Cardiovascular Disease in Adults: Evidence Report and Systematic Review for the US Preventive Services Task Force
Chou R, Dana T, Blazina I, Daeges M, Jeanne TL
JAMA · 436 citas
Etiquetas de revisión
Financiación no declaradaDatos neutrales que nuestra revisión registró sobre cómo se hizo este estudio. Describen el método, nunca si nos gusta el resultado.
Cómo se estudió
- Diseño
- Metaanálisis (indexado por PubMed)
- Estudiado en
- Personas
- Resultado principal
- Eventos clínicos como enfermedad o muerte
Quién lo pagó
- Financiación
- Financiación no declarada
Publicación
- Publicado
- 2016-11-13 · JAMA · vol. 316 · número 19 · pág. 2008
- Editorial
- American Medical Association
- Citado
- 568 citas · más que el 100% de estudios similares · 55.1× el promedio de su campo
- Impacto
- Entre el 10 % más citado de su campo
- Referencias
- 76 trabajos
- Acceso
- De pago
- Áreas de investigación
- Lipoproteins and Cardiovascular Health · Health Promotion and Cardiovascular Prevention · Cancer, Lipids, and Metabolism
- Palabras clave
- statins, cardiovascular disease prevention, all-cause mortality, cardiovascular mortality, stroke, myocardial infarction, statin intensity, primary prevention, USPSTF recommendations, cholesterol-lowering therapy, cardiovascular risk assessment
- MeSH
- humans, cardiovascular diseases, hydroxymethylglutaryl-coa reductase inhibitors, cause of death, risk reduction behavior, aged, middle aged, female, male, dyslipidemias, randomized controlled trials as topic
5 autores
- Roger Chou🇺🇸 · autor de correspondenciaOregon Health & Science University
- Tracy Dana🇺🇸Oregon Health & Science University
- Ian Blazina🇺🇸Oregon Health & Science University
- Monica Daeges🇺🇸Oregon Health & Science University
- Thomas L. Jeanne🇺🇸Oregon Health & Science University
Resumen
El texto original del estudio, en el idioma en que se publicó.
Importance
Cardiovascular disease (CVD), the leading cause of mortality and morbidity in the United States, may be potentially preventable with statin therapy.
Objective
To systematically review benefits and harms of statins for prevention of CVD to inform the US Preventive Services Task Force.
Data sources
Ovid MEDLINE (from 1946), Cochrane Central Register of Controlled Trials (from 1991), and Cochrane Database of Systematic Reviews (from 2005) to June 2016.
Study selection
Randomized clinical trials of statins vs placebo, fixed-dose vs titrated statins, and higher- vs lower-intensity statins in adults without prior cardiovascular events.
Data extraction and synthesis
One investigator abstracted data, a second checked data for accuracy, and 2 investigators independently assessed study quality using predefined criteria. Data were pooled using random-effects meta-analysis.
Main outcomes and measures
All-cause mortality, CVD-related morbidity or mortality, and harms.
Results
Nineteen trials (n = 71 344 participants [range, 95-17 802]; mean age, 51-66 years) compared statins vs placebo or no statin. Statin therapy was associated with decreased risk of all-cause mortality (risk ratio [RR], 0.86 [95% CI, 0.80 to 0.93]; I2 = 0%; absolute risk difference [ARD], -0.40% [95% CI, -0.64% to -0.17%]), cardiovascular mortality (RR, 0.69 [95% CI, 0.54 to 0.88]; I2 = 54%; ARD, -0.43% [95% CI, -0.75% to -0.11%]), stroke (RR, 0.71 [95% CI, 0.62 to 0.82]; I2 = 0; ARD, -0.38% [95% CI, -0.53% to -0.23%]), myocardial infarction (RR, 0.64 [95% CI, 0.57 to 0.71]; I2 = 0%; ARD, -0.81% [95% CI, -1.19 to -0.43%]), and composite cardiovascular outcomes (RR, 0.70 [95% CI, 0.63 to 0.78]; I2 = 36%; ARD, -1.39% [95% CI, -1.79 to -0.99%]). Relative benefits appeared consistent in demographic and clinical subgroups, including populations without marked hyperlipidemia (total cholesterol level <200 mg/dL); absolute benefits were higher in subgroups at higher baseline risk. Statins were not associated with increased risk of serious adverse events (RR, 0.99 [95% CI, 0.94 to 1.04]), myalgias (RR, 0.96 [95% CI, 0.79 to 1.16]), or liver-related harms (RR, 1.10 [95% CI, 0.90 to 1.35]). In pooled analysis, statins were not associated with increased risk of diabetes (RR, 1.05 [95% CI, 0.91 to 1.20]), although statistical heterogeneity was present (I2 = 52%), and 1 trial found high-intensity statins associated with increased risk (RR, 1.25 [95% CI, 1.05 to 1.49]). No trial directly compared titrated vs fixed-dose statins, and there were no clear differences based on statin intensity.
Conclusions and relevance
In adults at increased CVD risk but without prior CVD events, statin therapy was associated with reduced risk of all-cause and cardiovascular mortality and CVD events, with greater absolute benefits in patients at greater baseline risk.
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