Efficacy and safety of statin therapy in older people: a meta-analysis of individual participant data from 28 randomised controlled trials
Cholesterol Treatment Trialists' Collaboration
Lancet (London, England) · 581 citas
Etiquetas de revisión
Vínculos de autores con la industriaDatos 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 independiente
- Organización sin fines de lucro
- Wellcome Trust
- Universidad u hospital
- NIHR Bristol Biomedical Research Centre
- Organización sin fines de lucro
- Cancer Research UK
- Gobierno
- National Institute for Health and Care Research
- Organización sin fines de lucro
- British Heart Foundation
- Organización sin fines de lucro
- National Heart Foundation of Australia
- Gobierno
- Medical Research Council
- Gobierno
- National Health and Medical Research Council
- Gobierno
- National Institute for Health Research (NIHR)
- Autores
- Al menos un autor declara un vínculo económico con la industria
- Subvenciones
- British Heart Foundation (CH/1996001/9454); Medical Research Council (MC_UU_00017/4); National Institute for Health and Care Research (NF-SI-0513-10059)
Según 9 financiadores declarados y la declaración de financiación del texto completo.
Publicación
- Publicado
- 2019-01-31 · Lancet · vol. 393 · número 10170 · págs. 407–415
- Editorial
- Elsevier BV
- Citado
- 800 citas · más que el 100% de estudios similares · 27.4× el promedio de su campo
- Impacto
- Entre el 10 % más citado de su campo
- Referencias
- 47 trabajos
- Acceso
- Acceso abierto (revista híbrida) · CC-BY-NC-ND
- Áreas de investigación
- Lipoproteins and Cardiovascular Health · Cancer, Lipids, and Metabolism · Acute Myocardial Infarction Research
- Palabras clave
- statin therapy, older adults, age differences in treatment response, major vascular events, coronary events, stroke, coronary revascularization, vascular death, cancer incidence, LDL cholesterol lowering, high-intensity statin therapy, statin safety, cardiovascular risk reduction
- MeSH
- humans, hydroxymethylglutaryl-coa reductase inhibitors, age factors, aged, randomized controlled trials as topic
99 autores
- Jane Armitage
- Colin Baigent
- Elizabeth Helen Barnes
- D. J. Betteridge
- Lisa S. Blackwell
- Michael A. Blazing
- Louise J. Bowman
- Eugene Braunwald M. D
- Robert P. Byington
- Christopher Paul Cannon
- Michael B. Clearfield
- Helen Martina Colhoun
- Rory Collins
- Björn Dahlöf
- Kelly Davies
- Barry R. Davis
- James A. de Lemos
- John R. Downs
- Paul N. Durrington
- Jonathan Emberson
- Bengt Fellström
- Marcus D Flather
- Ian Ford
- Maria Grazia Franzosi
- Jordan Fulcher
- John Fuller
- Curt Daniel Furberg
- David Gordon
- Shinya Goto
- Antonio M. Gotto
- Heather J. Halls
- Charlie Harper
- C. MORTON HAWKINS
- William Guy Herrington
- G. A. Hitman
- Hallvard Holdaas
- Lisa Holland
- Alan G. Jardine
- J. Wouter Jukema
- John J.P. Kastelein
- Sharon Kean
- ANTHONY C. KEECH
- Adrienne C Kirby
- JOHN K. KJEKSHUS
- Genell L. Knatterud
- Robert H. Knopp
- Wolfgang Köenig
- Michael J. Koren
- Vera Krane
- Martin Landray
- John C. LaRosa
- Eva Lonn
- P. W. Macfarlane
- Stephen W MacMahon
- Aldo Pietro Maggioni
- Roberto Marchioli
- Ian C. Marschner
- Borislava Mihaylova
- Lemuel A. Moyé
- Sabina A. Murphy
- Haruo Nakamura
- Andrew Neil
- Connie B. Newman
- Rachel L O'Connell
- Chris J. Packard
- Sarah Parish
- Terje Pedersen
- Richard Peto
- Marc Alan Pfeffer
- Neil R Poulter
- David Preiss
- Christina A. Reith
- Paul M. Ridker
- Michele Robertson
- Frank M. Sacks
- Naveed A. Sattar
- Roland Erich Schmieder
- Patrick W.J.C. Serruys
- Peter Sever
- John Shaw
- Charles L. Shear
- Robert John Simes
- Peter Sleight
- Enti Spata
- Luigi Tavazzi
- Jonathan A. Tobert
- Gianni Tognoni
- Andrew Maxwell Tonkin
- Stella Trompet
- John Varigos
- Christoph Wanner
- Hans Wedel
- Harvey Douglas White
- John Wikstrand
- Lars Wilhelmsen
- Kate Wilson
- Robin Young
- Salim Yusuf
- Faiez M. Zannad
Resumen
El texto original del estudio, en el idioma en que se publicó.
Background
Statin therapy has been shown to reduce major vascular events and vascular mortality in a wide range of individuals, but there is uncertainty about its efficacy and safety among older people. We undertook a meta-analysis of data from all large statin trials to compare the effects of statin therapy at different ages.
Methods
In this meta-analysis, randomised trials of statin therapy were eligible if they aimed to recruit at least 1000 participants with a scheduled treatment duration of at least 2 years. We analysed individual participant data from 22 trials (n=134 537) and detailed summary data from one trial (n=12 705) of statin therapy versus control, plus individual participant data from five trials of more intensive versus less intensive statin therapy (n=39 612). We subdivided participants into six age groups (55 years or younger, 56-60 years, 61-65 years, 66-70 years, 71-75 years, and older than 75 years). We estimated effects on major vascular events (ie, major coronary events, strokes, and coronary revascularisations), cause-specific mortality, and cancer incidence as the rate ratio (RR) per 1·0 mmol/L reduction in LDL cholesterol. We compared proportional risk reductions in different age subgroups by use of standard χ2 tests for heterogeneity when there were two groups, or trend when there were more than two groups.
Findings
14 483 (8%) of 186 854 participants in the 28 trials were older than 75 years at randomisation, and the median follow-up duration was 4·9 years. Overall, statin therapy or a more intensive statin regimen produced a 21% (RR 0·79, 95% CI 0·77-0·81) proportional reduction in major vascular events per 1·0 mmol/L reduction in LDL cholesterol. We observed a significant reduction in major vascular events in all age groups. Although proportional reductions in major vascular events diminished slightly with age, this trend was not statistically significant (ptrend=0·06). Overall, statin or more intensive therapy yielded a 24% (RR 0·76, 95% CI 0·73-0·79) proportional reduction in major coronary events per 1·0 mmol/L reduction in LDL cholesterol, and with increasing age, we observed a trend towards smaller proportional risk reductions in major coronary events (ptrend=0·009). We observed a 25% (RR 0·75, 95% CI 0·73-0·78) proportional reduction in the risk of coronary revascularisation procedures with statin therapy or a more intensive statin regimen per 1·0 mmol/L lower LDL cholesterol, which did not differ significantly across age groups (ptrend=0·6). Similarly, the proportional reductions in stroke of any type (RR 0·84, 95% CI 0·80-0·89) did not differ significantly across age groups (ptrend=0·7). After exclusion of four trials which enrolled only patients with heart failure or undergoing renal dialysis (among whom statin therapy has not been shown to be effective), the trend to smaller proportional risk reductions with increasing age persisted for major coronary events (ptrend=0·01), and remained non-significant for major vascular events (ptrend=0·3). The proportional reduction in major vascular events was similar, irrespective of age, among patients with pre-existing vascular disease (ptrend=0·2), but appeared smaller among older than among younger individuals not known to have vascular disease (ptrend=0·05). We found a 12% (RR 0·88, 95% CI 0·85-0·91) proportional reduction in vascular mortality per 1·0 mmol/L reduction in LDL cholesterol, with a trend towards smaller proportional reductions with older age (ptrend=0·004), but this trend did not persist after exclusion of the heart failure or dialysis trials (ptrend=0·2). Statin therapy had no effect at any age on non-vascular mortality, cancer death, or cancer incidence.
Interpretation
Statin therapy produces significant reductions in major vascular events irrespective of age, but there is less direct evidence of benefit among patients older than 75 years who do not already have evidence of occlusive vascular disease. This limitation is now being addressed by further trials.
Funding
Australian National Health and Medical Research Council, National Institute for Health Research Oxford Biomedical Research Centre, UK Medical Research Council, and British Heart Foundation.
Resumen vía Europe PMC. Los derechos de autor siguen siendo de los autores o la editorial (CC BY-NC-ND).
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