title: Meta-Analyses of Statin Therapy for Primary Prevention Do Not Answer Key Questions: An Empirical Appraisal of 5 Years of Statin Meta-Analyses.
abstract: Although meta-analyses of statins in primary prevention are designed to provide doctors and patients with better evidence about the risks and potential benefits of treatment, they may ignore important patient-centered outcomes and concerns. We examined all meta-analyses of statins for primary prevention over the last 5 years. We assessed whether each meta-analysis addressed five key points: whether authors examined endpoints based on the use of statin therapy, and not stratified by low-density lipoprotein reduction; whether authors included only studies of statin versus placebo, and not varying doses or brands of statin; whether authors considered commonly cited harms; whether secondary prevention patients were excluded; and, whether overall mortality was examined. We examined 189 articles to identify 24 meta-analyses of statins that made claims regarding primary prevention. Six studies (25%) reported outcomes as a function of reduction in serum lipid levels rather than treatment received. Seven studies (29%) included trials of high-dose versus low-dose statin in their analysis. Five studies (21%) did not examine all-cause mortality. The majority of studies (n = 21, 88%) failed to exclude patients with known cardiovascular disease, and 22 (92%) studies failed to assess two of three common safety concerns. Nevertheless, most (n = 20, 83%) meta-analyses supported the use of statins in primary prevention. Based on our findings, we conclude that most recent meta-analyses of statins for primary prevention do not adequately address the question they seek to answer.
authors.affiliation: Department of Medicine, Northwestern University, Chicago, IL, USA.
authors.forename: Chetan
authors.initials: C
authors.lastname: Huded
authors.affiliation: Medical Oncology Branch, National Cancer Institute, National Institutes of Health, 10 Center Dr. 10/12N226, Bethesda, MD, 20892, USA. vinayak.prasad@nih.gov.
authors.forename: Vinay
authors.initials: V
authors.lastname: Prasad
mesh_terms: D002318:Cardiovascular Diseases / Q000401:mortality* / Q000517:prevention & control*; D004305:Dose-Response Relationship, Drug; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage*; D008055:Lipids / Q000097:blood; D015201:Meta-Analysis as Topic; D011322:Primary Prevention / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D008055:Lipids