title: Efficacy of statins for primary prevention in people at low cardiovascular risk: a meta-analysis.
abstract: BACKGROUND
  Statins were initially used to improve cardiovascular outcomes in people with established coronary artery disease, but recently their use has become more common in people at low cardiovascular risk. We did a systematic review of randomized trials to assess the efficacy and harms of statins in these individuals.
  
  
  METHODS
  We searched MEDLINE and EMBASE (to Jan. 28, 2011), registries of health technology assessments and clinical trials, and reference lists of relevant reviews. We included trials that randomly assigned participants at low cardiovascular risk to receive a statin versus a placebo or no statin. We defined low risk as an observed 10-year risk of less than 20% for cardiovascular-related death or nonfatal myocardial infarction, but we explored other definitions in sensitivity analyses.
  
  
  RESULTS
  We identified 29 eligible trials involving a total of 80,711 participants. All-cause mortality was significantly lower among patients receiving a statin than among controls (relative risk [RR] 0.90, 95% confidence interval [CI] 0.84-0.97) for trials with a 10-year risk of cardiovascular disease < 20% [primary analysis] and 0.83, 95% CI 0.73-0.94, for trials with 10-year risk < 10% [sensitivity analysis]). Patients in the statin group were also significantly less likely than controls to have nonfatal myocardial infarction (RR 0.64, 95% CI 0.49-0.84) and nonfatal stroke (RR 0.81, 95% CI 0.68-0.96). Neither metaregression nor stratified analyses suggested statistically significant differences in efficacy between high-and low-potency statins, or larger reductions in cholesterol.
  
  
  CONCLUSIONS
  Statins were found to be efficacious in preventing death and cardiovascular morbidity in people at low cardiovascular risk. Reductions in relative risk were similar to those seen in patients with a history of coronary artery disease.
authors: Department of Medicine, University of Alberta, Edmonton, Alta. mtonelli-admin@med.ualberta.ca
authors: Marcello
authors: M
authors: Tonelli
authors: Anita
authors: A
authors: Lloyd
authors: Fiona
authors: F
authors: Clement
authors: Jon
authors: J
authors: Conly
authors: Don
authors: D
authors: Husereau
authors: Brenda
authors: B
authors: Hemmelgarn
authors: Scott
authors: S
authors: Klarenbach
authors: Finlay A
authors: FA
authors: McAlister
authors: Natasha
authors: N
authors: Wiebe
authors: Braden
authors: B
authors: Manns
mesh_terms: D000789:Angina, Unstable / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D003920:Diabetes Mellitus / Q000453:epidemiology; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D009203:Myocardial Infarction / Q000453:epidemiology; D009204:Myocardial Revascularization / Q000706:statistics & numerical data; D009369:Neoplasms / Q000453:epidemiology; D011322:Primary Prevention; D016032:Randomized Controlled Trials as Topic; D012206:Rhabdomyolysis / Q000453:epidemiology; D018570:Risk Assessment; D020521:Stroke / Q000453:epidemiology
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors