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Statins not so helpful in primary prevention

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – Statins may be overused in patients without cardiovascular disease, according to a report in Archives of Internal Medicine.

The researchers pooled data from 11 randomized controlled trials in patients without cardiovascular disease, yielding 65,229 subjects. Mean ages ranged from 51 to 75 years, and the mean baseline low-density lipoprotein (LDL) cholesterol level was 138 mg/dL. Over 3.7 years of follow-up, patients in placebo/control arms had a mean LDL cholesterol level of 134 mg/dL vs. 94 mg/dL in those on statins.

There were 1,447 deaths among the 32,606 patients in the placebo/control arm, and 1,346 among the 32,623 in the treatment arm. Weighted mean all-cause mortality rates were 11.4 and 10.7 per 1,000 person-years, respectively. The risk ratio for all-cause mortality was 0.91, but this was not significant. There was no significant heterogeneity between studies. In addition, the researchers found that LDL cholesterol levels did not significantly predict all-cause mortality.

The researchers write, “There is little debate that…statin therapy among individuals with established coronary heart disease (CHD) not only prevents complications related to atherosclerosis but also reduces all-cause mortality.”

But, they add, “the present report suggests that all-cause mortality benefits are more modest in the short term, even among high-risk primary prevention populations, thereby indicating the need for further caution when extrapolating the potential benefits of statins on mortality to lower-risk primary prevention populations than to those shown herein.”

Reference:
http://archinte.ama-assn.org/cgi/content/short/170/12/1024 http://archinte.ama-assn.org/cgi/content/abstract/170/12/1032http://archinte.ama-assn.org/cgi/content/extract/170/12/1007 http://archinte.ama-assn.org/cgi/content/extract/170/12/1073
Dr. Kausik K. Ray, of the University of Cambridge in England, and colleagues