{"id":29082,"date":"2012-05-17T15:49:20","date_gmt":"2012-05-17T19:49:20","guid":{"rendered":"http:\/\/blogs.nejm.org\/cardioexchange\/?post_type=news&#038;p=29082"},"modified":"2012-05-17T15:49:20","modified_gmt":"2012-05-17T19:49:20","slug":"large-meta-analysis-finds-statins-effective-in-low-risk-patients","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/cardioexchange\/2012\/05\/17\/large-meta-analysis-finds-statins-effective-in-low-risk-patients\/","title":{"rendered":"Large Meta-Analysis Finds Statins Effective in Low-Risk Patients"},"content":{"rendered":"<p>A very large meta-analysis provides strong evidence that the relative reduction in vascular risk with statins is at least as great in low-risk patients as in high-risk patients.\u00a0The finding, write the authors, provides evidence that expansion of guidelines to lower-risk populations should be considered.<\/p>\n<p>In their <a href=\"http:\/\/www.thelancet.com\/journals\/lancet\/article\/PIIS0140-6736(12)60367-5\/fulltext\">paper in the <em>Lancet<\/em><\/a>, the Cholesterol Treatment Trialists\u2019 (CTT) Collaborators analyzed data from\u00a0134,537 patients in trials comparing statins with control therapy and 39,612 patients in trials comparing low- and high-dose statins. They examined the impact of statin therapy according to the baseline 5-year risk for a major vascular event on control therapy. Statin therapy caused a consistent reduction in the relative risk for major vascular events and all-cause mortality independent of other factors, including age, sex, baseline LDL cholesterol, or established CV disease.<\/p>\n<div>\n<p>Here are the rate ratios for major vascular events across five levels of risk at baseline (note that 1 mmol of LDL cholesterol is equivalent to about 39 mg\/dL of LDL):<\/p>\n<p><strong>\u00a0 \u00a0 \u00a0 \u00a0<\/strong><strong> <\/strong><span style=\"text-decoration: underline;\"><strong>5-Year Risk<\/strong><\/span><strong> \u00a0 \u00a0 \u00a0 \u00a0<\/strong><strong> \u00a0 <\/strong><span style=\"text-decoration: underline;\"><strong>Rate ratio per 1.0 mmol\/L of LDL reduction<\/strong><\/span><\/p>\n<ul>\n<li><em>&lt;5% \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0\u00a0 <\/em>0\u00b762 [99% CI 0\u00b747\u20130\u00b781]<\/li>\n<li><em>\u22655% to &lt;10% \u00a0 \u00a0 \u00a0 \u00a0\u00a0 <\/em>0\u00b769 [99% CI 0\u00b760\u20130\u00b779]<\/li>\n<li><em>\u226510% to &lt;20% \u00a0 \u00a0 \u00a0\u00a0 <\/em>0\u00b779 [99% CI 0\u00b774\u20130\u00b785]<\/li>\n<li><em>\u226520% to &lt;30% \u00a0 \u00a0 \u00a0\u00a0 <\/em>0\u00b781 [99% CI 0\u00b777\u20130\u00b786]<\/li>\n<li><em>\u00a0\u226530% \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 <\/em>0\u00b779 [99% CI 0\u00b774\u20130\u00b784]<\/li>\n<\/ul>\n<\/div>\n<p>The meta-analysis found no evidence for harm associated with statin therapy, including cancer or other nonvascular mortality.<\/p>\n<p>The authors note that current guidelines do not recommend statin therapy for people in the lowest two risk categories in the study, who are expected to have a 5-year event rate lower than 10%. As generic statins are highly cost-effective, they write, the study &#8220;suggests that these guidelines might need to be reconsidered.&#8221;<\/p>\n<p>In <a href=\"http:\/\/www.thelancet.com\/journals\/lancet\/article\/PIIS0140-6736(12)60694-1\">an accompanying comment<\/a>, Shah Ebrahim and Juan Casas ask whether everyone over the age of 50 should take statins. They calculate that, in the U.K., adoption of a threshold of 10% would classify 83% of men over age 50 and 56% of women over age 60 as needing statins.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>A very large meta-analysis provides strong evidence that the relative reduction in vascular risk with statins is at least as great in low-risk patients as in high-risk patients.\u00a0The finding, write the authors, provides evidence that expansion of guidelines to lower-risk populations should be considered. In their paper in the Lancet, the Cholesterol Treatment Trialists\u2019 (CTT) [&hellip;]<\/p>\n","protected":false},"author":196,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[7],"tags":[533,584],"class_list":["post-29082","post","type-post","status-publish","format-standard","hentry","category-prevention","tag-ldl-cholesterol","tag-statins"],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/29082","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/users\/196"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/comments?post=29082"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/29082\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/media?parent=29082"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/categories?post=29082"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/tags?post=29082"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}