It's been shown that lipid reduction with statins significantly improves cardiovascular outcomes. To more powerfully define effects on specific endpoints and subgroups, these investigators performed a meta-analysis of data on more than 90,000 subjects from 14 trials of statins for primary and secondary prevention. Most subjects had one or more other risk factors, and about half had known coronary disease. Most of the trials were supported by the pharmaceutical industry.
Because the degree of lipid reduction differed among trials and subgroups, outcomes were adjusted and expressed as proportional reductions in cardiovascular events per mmol/L reduction in LDL (1 mmol/L=39 mg/dL). Follow-up ranged from 2 to 6 years. Deaths from coronary heart disease were reduced by 19% per mmol/L reduction in LDL, deaths from any vascular cause by 17%, and deaths from any cause by 12%. First major coronary events and all first major vascular events were reduced by 10% to 14% per mmol/L reduction in LDL in the first year and by 20% to 30% in each of the next 5 years. All of these differences were significant, and similar results were seen in all subgroups by age, sex, lipid levels, and histories of hypertension, diabetes, and vascular disease. Statin therapy did not increase the incidence of cancer or rhabdomyolysis.
This analysis suggests that lowering LDL cholesterol by a fixed amount confers a consistent proportional cardiovascular benefit, regardless of most baseline characteristics, including LDL levels themselves. Benefits of LDL reduction seem to begin early and to accrue over time with minimal risk. These data should encourage aggressive lipid lowering in broader populations of patients who are at high risk for vascular events.
Reference:
Cholesterol Treatment Trialists’ (CTT) Collaborators. Efficacy and safety of cholesterol-lowering treatment: Prospective meta-analysis of data from 90 056 participants in 14 randomised trials of statins. Lancet 2005 Oct 8; 366:1267-78.