In patient with cardiovascular risk factors but not overt cardiovascular disease, does lowering cholesterol with a statin decrease mortality?

Lowering cholesterol in 173 patients at risk for developing cardiovascular disease for slightly more than 4 years prevented 1 of them from dying prematurely. One major coronary event was prevented for every 81 patients, and one cerebrovascular event was prevented for every 245 patients treated. (LOE = 1a)

Brugts JJ, Yetgin T, Hoeks SE, et al. The benefits of statins in people without established cardiovascular disease but with cardiovascular risk factors: meta-analysis of randomised controlled trials. BMJ 2009;338:b2376.  [PMID:19567909]

Meta-analysis (randomized controlled trials)

Self-funded or unfunded

Various (meta-analysis)

We can split adults into 3 groups according to their risk for dying prematurely as a result of heart disease: (1) low: those without risk factors for heart disease; (2) higher: those who have risk factors, and, (3) highest: those who have existing heart disease. The distinction is important, since the impact of preventive measures, such as cholesterol lowering, depends on this baseline risk. The researchers conducting this study used standard methodology to conduct this meta-analysis, identifying and including 10 studies that assessed the value of cholesterol lowering in patients without established heart disease but with risk factors. Average total cholesterol at the start ranged from 185 mg/dL (4.8 mmol/L) to 270 mg/dL (7.0 mmol/L) across the studies. In follow-up ranging from 1.9 years to 5.5 years, mortality due to any cause occurred in 5.7% of untreated patients as compared with 5.1% of treated patients. This difference translates into 1 death prevented for every 173 patients treated for an average of 4.1 years, with a possible range of 109 to 428 (number needed to treat [NNT] = 173; 95% CI, 109-428). Major coronary events were also diminished, with 1 event prevented for every 81 patients treated for 4.9 years (NNT = 81; 62 - 117), as were cerebrovascular events (NNT = 245; 160 - 516). In studies presenting rates for men and women, there was similar benefit.