This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (60)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Topic Collections  • Lipids and Lipid Disorders  • Cardiovascular System  • Evidence-Based Medicine  • Cardiovascular Disease/ Myocardial Infarction  • Alert me on articles by topic  Social Bookmarking   What's this?

Timothy J. Wilt, MD, MPH; Hanna E. Bloomfield, MD, MPH; Roderick MacDonald, MS; David Nelson, PhD; Indulis Rutks, BS; Michael Ho, MD; Gregory Larsen, MD; Anthony McCall, MD, PhD; Sandra Pineros, MPH; Anne Sales, PhD

Arch Intern Med. 2004;164:1427-1436.

Background  We conducted a meta-analysis of patients with coronary heart disease (CHD) to determine the effectiveness of statin therapy; whether effectiveness varied according to patient characteristics, outcomes, or pretreatment low-density lipoprotein cholesterol (LDL-C) levels; and the optimal LDL-C goal and the level at which to initiate statin therapy.

Methods  Randomized trials or systematic reviews for secondary prevention of CHD with statin therapy published between January 1966 and December 2002 were identified through MEDLINE and the Cochrane Library. Studies were included if they randomly assigned adults with CHD to statin therapy or control, enrolled at least 100 individuals per arm, reported clinical outcomes and LDL-C levels, and were published as full studies in English. Two reviewers abstracted data using a prospectively designed protocol.

Results  Twenty-five studies enrolling 69 511 individuals were included. Participants in 19 placebo-controlled trials had a mean age of 63 years and a mean pretreatment LDL-C level of 149 mg/dL (3.85 mmol/L); 23% were women. Statin therapy reduced CHD mortality or nonfatal myocardial infarction 25% (relative risk [RR], 0.75; 95% confidence interval [CI], 0.71-0.79), all-cause mortality 16% (RR, 0.84; 95% CI, 0.79-0.89), and CHD mortality 23% (RR, 0.77; 95% CI, 0.71-0.83). Beneficial effects were seen in women and the elderly. There were no data to determine whether lowering the LDL-C level to less than 100 mg/dL (<2.59 mmol/L) was superior to lowering it to 100 to 130 mg/dL (2.59-3.36 mmol/L). Meta-regression analyses revealed risk reductions for CHD mortality or nonfatal myocardial infarction and major vascular events across available pretreatment LDL-C levels.

Conclusion  Statin therapy reduces mortality and morbidity in adults with CHD, even at pretreatment LDL-C levels as low as 100 mg/dL (2.59 mmol/L).

From the Center for Chronic Disease Outcomes Research, Minneapolis VA Medical Center, Minneapolis, Minn (Drs Wilt, Bloomfield, and Nelson and Messrs MacDonald and Rutks); Cardiology and Health Services Research, Denver VA Medical Center, Denver, Colo (Dr Ho); Department of Cardiology, Portland VA Medical Center, Portland, Ore (Dr Larsen); Department of Internal Medicine, University of Virginia Health System, Charlottesville (Dr McCall); and Ischemic Heart Disease Quality Enhancement Research Initiative, VA Puget Sound Health Care System, Seattle, Wash (Ms Pineros and Dr Sales). The authors have no relevant financial interest in this article.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Continuation of Statin Treatment and Mortality: A Note of Caution on Excessive Benefits
Filion et al.
Arch Intern Med 2009;169:1080-1080.
FULL TEXT  

Statins as Potential Antimalarial Drugs: Low Relative Potency and Lack of Synergy with Conventional Antimalarial Drugs
Wong and Davis
Antimicrob. Agents Chemother. 2009;53:2212-2214.
ABSTRACT | FULL TEXT  

ABT-335, the Choline Salt of Fenofibric Acid, Does Not Have a Clinically Significant Pharmacokinetic Interaction With Rosuvastatin in Humans
Zhu et al.
J Clin Pharmacol 2009;49:63-71.
ABSTRACT | FULL TEXT  

CHAPTER 11 Clinical Pharmacology of Cardiovascular Drugs
Zannad et al.
ESC Textbook of Cardiovascular Medicine 2009;2:med-9780199566990-chapter-med-9780199566990-chapter.
ABSTRACT | FULL TEXT  

A Meta-Analysis of 17 Randomized Trials of a Percutaneous Coronary Intervention-Based Strategy in Patients With Stable Coronary Artery Disease
Schomig et al.
J Am Coll Cardiol 2008;52:894-904.
ABSTRACT | FULL TEXT  

Activation of Liver X Receptors Prevents Statin-induced Death of 3T3-L1 Preadipocytes
Madsen et al.
J. Biol. Chem. 2008;283:22723-22736.
ABSTRACT | FULL TEXT  

Exercise and cardiovascular risk reduction: Time to update the rationale for exercise?
Green et al.
J. Appl. Physiol. 2008;105:766-768.
FULL TEXT  

Toward 'Pain-Free' Statin Prescribing: Clinical Algorithm for Diagnosis and Management of Myalgia
Jacobson
Mayo Clin Proc. 2008;83:687-700.
ABSTRACT | FULL TEXT  

Effect of Pretreatment With Statins on Ischemic Stroke Outcomes
Reeves et al.
Stroke 2008;39:1779-1785.
ABSTRACT | FULL TEXT  

Statins for secondary prevention in elderly patients: a hierarchical bayesian meta-analysis.
Afilalo et al.
J Am Coll Cardiol 2008;51:37-45.
ABSTRACT | FULL TEXT  

Sex differences in the effectiveness of statins after myocardial infarction
Karp et al.
CMAJ 2007;176:333-338.
ABSTRACT | FULL TEXT  

The Value Of Coronary Heart Disease Care For The Elderly: 1987-2002
Rosen et al.
Health Aff (Millwood) 2007;26:111-123.
ABSTRACT | FULL TEXT  

Primary Prevention of Cardiovascular Diseases With Statin Therapy: A Meta-analysis of Randomized Controlled Trials
Thavendiranathan et al.
Arch Intern Med 2006;166:2307-2313.
ABSTRACT | FULL TEXT  

Statin therapy and risks for death and hospitalization in chronic heart failure.
Go et al.
JAMA 2006;296:2105-2111.
ABSTRACT | FULL TEXT  

Healthy Lifestyle Factors in the Primary Prevention of Coronary Heart Disease Among Men: Benefits Among Users and Nonusers of Lipid-Lowering and Antihypertensive Medications
Chiuve et al.
Circulation 2006;114:160-167.
ABSTRACT | FULL TEXT  

Cholesteryl Ester Transfer Protein Inhibition: Effect on Reverse Cholesterol Transport?
Rensen and Havekes
Arterioscler. Thromb. Vasc. Bio. 2006;26:681-684.
FULL TEXT  

Role of cAMP Response Element Binding Protein in Cardiovascular Remodeling: Good, Bad, or Both?
Ichiki
Arterioscler. Thromb. Vasc. Bio. 2006;26:449-455.
ABSTRACT | FULL TEXT  

Statin and beta-blocker therapy and the initial presentation of coronary heart disease.
Go et al.
ANN INTERN MED 2006;144:229-238.
ABSTRACT | FULL TEXT  

Lipid Testing and Lipid-Lowering Therapy in Hospitalized Ischemic Stroke and Transient Ischemic Attack Patients: Results From a Statewide Stroke Registry
Mullard et al.
Stroke 2006;37:44-49.
ABSTRACT | FULL TEXT  

Pleiotropic Effects of Statins: Benefit Beyond Cholesterol Reduction?: A Meta-Regression Analysis
Robinson et al.
J Am Coll Cardiol 2005;46:1855-1862.
ABSTRACT | FULL TEXT  

Update in Endocrinology
Wartofsky
ANN INTERN MED 2005;143:673-682.
FULL TEXT  

Identification of the Four Conventional Cardiovascular Disease Risk Factors by Dutch General Practitioners
van Wyk et al.
Chest 2005;128:2521-2527.
ABSTRACT | FULL TEXT  

Getting There: Statin Plus Ezetimibe for Low-Density Lipoprotein Cholesterol Goals
Hurley and Isley
Mayo Clin Proc. 2005;80:585-586.
 

Other articles noted
Evid. Based Med. 2005;10:31-32.
FULL TEXT