Henock G Yebyo1, Hélène E Aschmann2, Marco Kaufmann2, Milo A Puhan3. 1. Department of Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, Zurich, Switzerland; School of Public Health, Mekelle University, Ayder, Mekelle, Ethiopia. 2. Department of Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, Zurich, Switzerland. 3. Department of Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, Zurich, Switzerland. Electronic address: miloalan.puhan@uzh.ch.
Abstract
The current guidelines of statins for primary cardiovascular disease (CVD) prevention were based on results from systematic reviews and meta-analyses that suffer from limitations. METHODS: We searched in PubMed for existing systematic reviews and individual open-label or double-blinded randomized controlled trials that compared a statin with a placebo or another, which were published in English until January 01, 2018. We performed a random-effect pairwise meta-analysis of all statins as a class and network meta-analysis for the specific statins on different benefit and harm outcomes. RESULTS: In the pairwise meta-analyses, statins as a class showed statistically significant risk reductions on non-fatal MI (risk ratio [RR] 0.62, 95% CI 0.53-0.72), CVD mortality (RR 0.80, 0.71-0.91), all-cause mortality (RR 0.89, 0.85-0.93), non-fatal stroke (RR 0.83, 0.75-0.92), unstable angina (RR 0.75, 0.63-0.91), and composite major cardiovascular events (RR 0.74, 0.67-0.81). Statins increased statistically significantly relative and absolute risks of myopathy (RR 1.08, 1.01-1.15; Risk difference [RD] 13, 2-24 per 10,000 person-years); renal dysfunction (RR 1.12, 1.00-1.26; RD 16, 0-36 per 10,000 person-years); and hepatic dysfunction (RR 1.16, 1.02-1.31; RD 8, 1-16 per 10,000 person-years). The drug-level network meta-analyses showed that atorvastatin and rosuvastatin were most effective in reducing CVD events while atorvastatin appeared to have the best safety profile. CONCLUSIONS: All statins showed statistically significant risk reduction of CVD and all-cause mortality in primary prevention populations while increasing the risk for some harm risks. However, the benefit-harm profile differed by statin type. A quantitative assessment of the benefit-harm balance is thus needed since meta-analyses alone are insufficient to inform whether statins provide net benefit.
The current guidelines of statins for primary cardiovascular disease (CVD) prevention were based on results from systematic reviews and meta-analyses that suffer from limitations. METHODS: We searched in PubMed for existing systematic reviews and individual open-label or double-blinded randomized controlled trials that compared a statin with a placebo or another, which were published in English until January 01, 2018. We performed a random-effect pairwise meta-analysis of all statins as a class and network meta-analysis for the specific statins on different benefit and harm outcomes. RESULTS: In the pairwise meta-analyses, statins as a class showed statistically significant risk reductions on non-fatal MI (risk ratio [RR] 0.62, 95% CI 0.53-0.72), CVD mortality (RR 0.80, 0.71-0.91), all-cause mortality (RR 0.89, 0.85-0.93), non-fatal stroke (RR 0.83, 0.75-0.92), unstable angina (RR 0.75, 0.63-0.91), and composite major cardiovascular events (RR 0.74, 0.67-0.81). Statins increased statistically significantly relative and absolute risks of myopathy (RR 1.08, 1.01-1.15; Risk difference [RD] 13, 2-24 per 10,000 person-years); renal dysfunction (RR 1.12, 1.00-1.26; RD 16, 0-36 per 10,000 person-years); and hepatic dysfunction (RR 1.16, 1.02-1.31; RD 8, 1-16 per 10,000 person-years). The drug-level network meta-analyses showed that atorvastatin and rosuvastatin were most effective in reducing CVD events while atorvastatin appeared to have the best safety profile. CONCLUSIONS: All statins showed statistically significant risk reduction of CVD and all-cause mortality in primary prevention populations while increasing the risk for some harm risks. However, the benefit-harm profile differed by statin type. A quantitative assessment of the benefit-harm balance is thus needed since meta-analyses alone are insufficient to inform whether statins provide net benefit.
Authors: Qiaoxi Chen; Kate Lapane; Anthony P Nunes; Jennifer Tjia; Julie Hugunin; Matthew Alcusky Journal: J Clin Pharm Ther Date: 2021-08-31 Impact factor: 2.145
Authors: Matthew Alcusky; Jennifer Tjia; David D McManus; Anne L Hume; Marc Fisher; Kate L Lapane Journal: J Gen Intern Med Date: 2020-04-06 Impact factor: 5.128
Authors: Zhen Zhou; Andrea J Curtis; Michael E Ernst; Joanne Ryan; Sophia Zoungas; Rory Wolfe; John J McNeil; Anne M Murray; Christopher M Reid; Enayet K Chowdhury; Robyn L Woods; Andrew M Tonkin; Mark R Nelson Journal: Eur J Clin Pharmacol Date: 2021-10-26 Impact factor: 2.953
Authors: Michał Kosowski; Joanna Smolarczyk-Kosowska; Marcin Hachuła; Mateusz Maligłówka; Marcin Basiak; Grzegorz Machnik; Robert Pudlo; Bogusław Okopień Journal: Molecules Date: 2021-05-11 Impact factor: 4.411
Authors: Kamal Awad; Maged Mohammed; Mahmoud Mohamed Zaki; Abdelrahman I Abushouk; Gregory Y H Lip; Michael J Blaha; Carl J Lavie; Peter P Toth; J Wouter Jukema; Naveed Sattar; Maciej Banach Journal: BMC Med Date: 2021-06-22 Impact factor: 8.775