[Clinical benefits of cholesterol lowering treatments. Meta-analysis of randomized therapeutic trials].
A meta-analysis of the 7 available randomized cholesterol lowering trials (2 on statins, 2 on fibrates, 2 on resins and 1 on diet) demonstrates a significant 24% relative reduction in the frequency of fatal and non-fatal coronary events, leading to a significant 14% relative reduction in coronary disease related mortality. For total mortality, the statin trials were not comparable with other treatments where there was a trend to overmortality. With the 2 statin trials, there was a nonsignificant 13% reduction in total mortality.
A meta-analysis of the 13 available randomized trials (3 with clofribrate, 1 with gemfibrozil, 2 with nicotinic acid, and 4 with diet) showed a significant 21% reduction in the frequency of fatal and non-fatal coronary events, coronary mortality and total mortality. For total mortality, only the result of the 2 statin trials was significant (-20%). BENEFICIAL EFFECT OF STATINS, ABSOLUTE VALUES: Measured as the number of patients to treat for 5 years in order to avoid 1 event (NNT), there is a clinically pertinent benefit of secondary prevention (NNT = 15 for events, NNT = 30 for coronary mortality). The absolute value is weaker when patients with minimally elevated cholesterol levels are included. For primary prevention, the absolute value is low with NNT = 44 for events and NNT = 300 for coronary mortality. In addition, as these results were obtained in trials including populations with a much higher risk than the general French population, the absolute beneficial effect may not be pertinent in France except in high-risk patients who present, in addition to a high cholesterol level, other cardiovascular risk factors.
Cucherat
M
M
Service de Pharmacologie clinique-EA 643, Hôpitaux de Lyon, Université Lyon 1. mcu@upcl.univ-lyon1.fr
Lièvre
M
M
Gueyffier
F
F
D000924:Anticholesteremic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D005602:France; D006801:Humans; D006937:Hypercholesterolemia / Q000188:drug therapy* / Q000401:mortality; D009203:Myocardial Infarction / Q000401:mortality / Q000517:prevention & control; D016032:Randomized Controlled Trials as Topic; D015996:Survival Rate; D016896:Treatment Outcome
D000924:Anticholesteremic Agents
Bénéfices cliniques des traitements hypocholestérolémiants. Méta-analyse des essais thérapeutiques randomisés.