Cholesterol lowering benefits patients at risk for CHD
Clinical QuestionIn patient with cardiovascular risk factors but not overt cardiovascular disease, does lowering cholesterol with a statin decrease mortality?
Bottom LineLowering 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)
ReferenceBrugts 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]
Study DesignMeta-analysis (randomized controlled trials)
FundingSelf-funded or unfunded
SynopsisWe 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.
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Barry, Henry, et al., editors. "Cholesterol Lowering Benefits Patients at Risk for CHD." EE+ POEM Archive, John Wiley & Sons, 2019. Evidence Central, evidence.unboundmedicine.com/evidence/view/infoPOEMs/426879/all/Cholesterol_lowering_benefits_patients_at_risk_for_CHD.
Cholesterol lowering benefits patients at risk for CHD. In: Barry HH, Ebell MHM, Shaughnessy AFA, et al, eds. EE+ POEM Archive. John Wiley & Sons; 2019. https://evidence.unboundmedicine.com/evidence/view/infoPOEMs/426879/all/Cholesterol_lowering_benefits_patients_at_risk_for_CHD. Accessed March 28, 2023.
Cholesterol lowering benefits patients at risk for CHD. (2019). In Barry, H., Ebell, M. H., Shaughnessy, A. F., & Slawson, D. C. (Eds.), EE+ POEM Archive. John Wiley & Sons. https://evidence.unboundmedicine.com/evidence/view/infoPOEMs/426879/all/Cholesterol_lowering_benefits_patients_at_risk_for_CHD
Cholesterol Lowering Benefits Patients at Risk for CHD [Internet]. In: Barry HH, Ebell MHM, Shaughnessy AFA, Slawson DCD, editors. EE+ POEM Archive. John Wiley & Sons; 2019. [cited 2023 March 28]. Available from: https://evidence.unboundmedicine.com/evidence/view/infoPOEMs/426879/all/Cholesterol_lowering_benefits_patients_at_risk_for_CHD.
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TY - ELEC T1 - Cholesterol lowering benefits patients at risk for CHD ID - 426879 ED - Barry,Henry, ED - Ebell,Mark H, ED - Shaughnessy,Allen F, ED - Slawson,David C, BT - EE+ POEM Archive UR - https://evidence.unboundmedicine.com/evidence/view/infoPOEMs/426879/all/Cholesterol_lowering_benefits_patients_at_risk_for_CHD PB - John Wiley & Sons DB - Evidence Central DP - Unbound Medicine ER -