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A Meta-analysis

Susan D. Ross, MD; I. Elaine Allen, PhD; Janet E. Connelly, BS; Bonnie M. Korenblat, PhD; M. Eugene Smith, BS; Daren Bishop, BA; Don Luo, PhD

Arch Intern Med. 1999;159:1793-1802.

Objective  To determine the risk of cardiovascular events and death in patients receiving statin treatment for cholesterol regulation.

Methods  Systematic review and meta-analysis of all randomized controlled trials that were published as of April 15, 1997. Primary or secondary prevention trials or regression trials were eligible.

Main Outcome Measures  All-cause mortality, fatal myocardial infarction (MI) or stroke, nonfatal MI or stroke, angina, and withdrawal from the studies. Both random- and fixed-effects models were run for the outcomes of interests, and results are expressed as odds ratios (ORs). Sensitivity analyses tested the impact of the study type and duration, statin treatment type, and control arm event rates. Intent-to-treat denominators were used whenever they were available, and the number needed to treat was calculated when appropriate.

Results  Seventeen studies (21,303 patients) were included (2 secondary prevention studies, 5 mixed primary-secondary prevention population studies, and 10 regression trials). Treatment groups included lovastatin (t=5), pravastatin (t=10), and simvastatin (t=3). For all-cause mortality, the OR was 0.76 (95% confidence interval [CI], 0.67-0.86) in favor of receiving statin treatment; for fatal MI, the OR was 0.61 (95% CI, 0.48-0.78); for nonfatal MI, the OR was 0.69 (0.54-0.88); for fatal stroke, the OR was 0.77 (95% CI, 0.57-1.04); for nonfatal stroke, the OR was 0.69 (95% CI, 0.54-0.88); and for angina, the OR was 0.70 (95% CI, 0.65-0.76).

Conclusions  Patients who received statin treatment demonstrated a 20% to 30% reduction in death and major cardiovascular events compared with patients who received placebo. This advantage was generally present across study types and statin treatment types and for patients with less severe dyslipidemias. The benefit in clinical outcomes was noticeable as early as 1 year.

From MetaWorks Inc, Boston, Mass (Drs Ross, Allen, and Luo, Ms Connelly, and Mr Bishop), and Bayer Corp, West Haven, Conn (Dr Korenblat and Mr Smith).

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