| The efficacy and safety of intensive statin therapy: a meta-analysis of randomized trials. | |
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MedLine Citation:
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PMID: 18299547 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Recent lipid guidelines recommend aggressive low-density lipoprotein (LDL) cholesterol lowering in patients with coronary artery disease. To clarify the evidence for this recommendation, we conducted a meta-analysis of randomized controlled trials that compared different intensities of statin therapy. METHODS: We searched electronic databases (MEDLINE, EMBASE, Cochrane Central Registery of Controlled Trials, Web of Science) for randomized controlled trials published up to July 19, 2007, that compared statin regimens of different intensities in adults with coronary artery disease and that reported cardiovascular events or mortality. Data were pooled using random-effects models to calculate odds ratios (OR). RESULTS: A total of 7 trials (29 395 patients) were included. Compared with less intensive statin regimens, more intensive regimens further reduced LDL levels (0.72 mmol/L reduction, 95% confidence interval [CI] 0.60-0.84 mmol/L), and reduced the risk of myocardial infarction (OR 0.83, 95% CI 0.77-0.91) and stroke (OR 0.82, 95% CI 0.71-0.95). Although there was no effect on mortality among patients with chronic coronary artery disease (OR 0.96, 95% CI 0.80-1.14), all-cause mortality was reduced among patients with acute coronary syndromes treated with more intensive statin regimens (OR 0.75, 95% CI 0.61-0.93). Compared with lower intensity regimens, more intensive regimens were associated with small absolute increases in rates of drug discontinuation (2.5%), elevated levels of aminotransferases (1%) and myopathy (0.5%), and there was no difference in noncardiovascular mortality. All 7 trials reported events by randomization arm rather than by LDL level achieved. About half of the patients treated with more intensive statin therapy did not achieve an LDL level of less than 2.0 mmol/L, and none of the trials tested combination therapies. INTERPRETATION: Our analysis supports the use of more intensive statin regimens in patients with established coronary artery disease. There is insufficient evidence to advocate treating to particular LDL targets, using combination lipid-lowering therapy to achieve these targets or for using more intensive regimens in patients without established coronary artery disease. |
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Authors:
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Kiranbir Josan; Sumit R Majumdar; Finlay A McAlister |
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Publication Detail:
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Type: Journal Article; Meta-Analysis |
Journal Detail:
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Title: CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne Volume: 178 ISSN: 1488-2329 ISO Abbreviation: CMAJ Publication Date: 2008 Feb |
Date Detail:
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Created Date: 2008-02-26 Completed Date: 2008-03-27 Revised Date: 2009-11-18 |
Medline Journal Info:
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Nlm Unique ID: 9711805 Medline TA: CMAJ Country: Canada |
Other Details:
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Languages: eng Pagination: 576-84 Citation Subset: AIM; IM |
Affiliation:
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Division of General Internal Medicine, Department of Medicine, University of Alberta, Edmonton, Alta. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Acute Coronary Syndrome
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drug therapy,
epidemiology Alanine Transaminase / blood Aspartate Aminotransferases / blood Cholesterol, LDL / blood Coronary Artery Disease / blood, drug therapy*, mortality Humans Hydroxymethylglutaryl-CoA Reductase Inhibitors / administration & dosage* Myocardial Infarction / epidemiology, prevention & control Randomized Controlled Trials as Topic Stroke / epidemiology Treatment Outcome |
| Chemical | |
Reg. No./Substance:
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0/Cholesterol, LDL; 0/Hydroxymethylglutaryl-CoA Reductase Inhibitors; EC 2.6.1.1/Aspartate Aminotransferases; EC 2.6.1.2/Alanine Transaminase |
| Comments/Corrections | |
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