The shifting balance of data for and against broader use of statin treatment tilted again toward more liberal use, with results from a meta-analysis of more than 170,000 participants showing a clear, positive, overall effect from statin treatment in all types of adults, even those with a relatively low baseline risk for major vascular events.
Among people with a 5-year risk of major vascular events lower than 10%, each 1-mmol/L (39-mg/dL) reduction in low-density lipoprotein cholesterol from statin treatment produced an absolute reduction in 11 major vascular events per 1,000 people during 5 years of treatment, reported the Cholesterol Treatment Trialists Collaborators, a team based in Oxford, England, in an article published online May 16 in the Lancet (doi: 10.1016./S0140-6736(12)60367-5).
The analysis showed that "statin therapy significantly reduced the risk of major vascular events in individuals with 5-year risk lower than 10% (in whom the mean risks were 2%-6% for major coronary events plus 3% for other major vascular events), even in those with no previous history of vascular disease, diabetes, or chronic kidney disease." The meta-analysis included data on 174,149 people from 27 controlled trials, and included participants with a broad range of baseline cardiovascular-event risk, ranging from a 5-year risk of less than 5% to a risk of greater than 30%
The degree of relative risk reduction among trial participants with a 5-year risk of less than 5%, or 5% to less than 10%, was roughly similar to the risk reduction seen in participants with higher baseline risk levels, even in those with a baseline 5-year risk of 30% or more. The overall relative risk reduction for all people at all baseline risk levels in the analysis was 21% for each 1-mmol/L reduction in LDL cholesterol achieved with statin treatment. For those with a baseline, 5-year risk of less than 5%, the relative risk reduction was 38% for each 1-mmol/L reduction in LDL cholesterol, and for those with a baseline 5-year risk of 5% to less than 10%, the relative risk reduction from statin use was 31% for this level of LDL reduction.
Based on this new analysis, the authors concluded that the benefits of statin treatment, even in people at low risk, "greatly" outweigh the risks: "Any long-term effects of any small excesses in hemorrhagic strokes and in diagnoses of diabetes [triggered by statin use] are not associated with long-term effects on major vascular events that are sufficiently large to outweigh the persistent benefits of statin therapy," they wrote.
Some members of the study-writing committee said that they received reimbursement of costs to participate in scientific meetings from the pharmaceutical industry. Two of the authors received honoraria from Solvay for lectures related to the meta-analysis.