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Evidence summaries

Statin Treatment and Risk of Coronary Heart Disease

The reduction in LDL-cholesterol associated with statin drug treatment results in a decreased risk of coronary heart disease and all-cause mortality. The risk reduction is similar for men and women, and for elderly and middle-aged people. Level of evidence: "A"

A systematic review 1 including 5 studies with a total of 30 817 subjects was abstracted in DARE. Statin drug treatment was associated with a mean reduction (weighted by sample size) of 20% in the total cholesterol level, 28% in LDL-cholesterol levels, and 13% in triglyceride levels. Overall, statin drug treatment reduced the risk of major coronary events by 31% (95% CI: 26 to 36) and fatal coronary disease by 29% (95% CI: 20 to 36). Compared with the control groups, active treatment was associated with an absolute risk reduction in coronary disease of 36 events and 13 deaths per 1 to000 patients. The NNT was 28 to prevent a major coronary event and 75 to prevent a death from coronary disease. Compared with the control groups, those receiving active treatment had a 21% reduction in all-cause mortality (95% CI: 14 to 28) and a 27% reduction in the odds of cardiovascular mortality (95% CI: 19 to 34). Active treatment was also associated with an absolute risk reduction of 16 and 14 deaths per 1 to000 patients from all-causes and cardiovascular disease, respectively. The corresponding NNTs to prevent death were 61 (all-causes) and 69 (cardiovascular disease). Noncardiovascular mortality was similar in both the active treatment and control groups, with an OR of 0.93 (95% CI: 0.81 to 1.07).

The risk reduction in major coronary events was similar for women (29%, 95% CI: 13 to 42) and for men (31%, 95% CI: 26 to 35). The overall, proportional risk reduction was similar for persons aged at least 65 years (32%, 95% CI: 23 to 39) and those aged younger than 65 years (31%, 95% Cl: 24 to 36).

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