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Statins for the primary prevention of cardiovascular disease: an overview of systematic reviews
  1. Paula Byrne1,
  2. John Cullinan1,
  3. Amelia Smith2,
  4. Susan M Smith3
  1. 1J.E. Cairnes School of Business and Economics, National University of Ireland Galway, Galway, Ireland
  2. 2Department of Pharmacology and Therapeutics, University of Dublin Trinity College, Dublin, Ireland
  3. 3HRB Centre for Primary Care Research and Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
  1. Correspondence to Ms Paula Byrne; pbyrne82{at}gmail.com

Abstract

Objective To synthesise evidence from exclusively primary prevention data on the effectiveness of statins for prevention of cardiovascular disease (CVD), including stroke, and outcomes stratified by baseline risk and gender.

Design Overview of systematic reviews (SRs) using Revised-AMSTAR approach to assess quality.

Data sources Cochrane Database of Systematic Reviews, MEDLINE, Embase, PubMed, Scopus and PROSPERO to June 2017.

Eligibility criteria for selecting studies SRs of randomised control trials (RCTs) or individual patient data (IPD) from RCTs, examining the effectiveness of statins versus placebo or no treatment on all-cause mortality, coronary heart disease, CVD (including stroke) and composite endpoints, with stratification by baseline risk and gender.

Data extraction and synthesis Two independent reviewers extracted data and assessed methodological quality. A narrative synthesis was conducted.

Results Three SRs were included. Quality of included SRs was mixed, and none reported on the risk of bias of included trials.

We found trends towards reduced all-cause mortality in all SRs (RR 0.91 [95% CI 0.85 to 0.97]), (RR 0.91 [95% CI 0.83 to 1.01]) and (RR 0.78 [95% CI 0.53 to 1.15]) though it was not statistically significant in two SRs. When stratified by baseline risk, the effect on all-cause mortality was no longer statistically significant except in one medium risk category. One review reported significant reductions (RR 0.85 [95% CI 0.77 to 0.95]) in vascular deaths and non-significant reductions in non-vascular deaths (RR 0.97 [95% CI 0.88 to 1.07]). There were significant reductions in composite outcomes overall, but mixed results were reported in these when stratified by baseline risk. These reviews included studies with participants considered risk equivalent to those with established CVD.

Conclusions There is limited evidence on the effectiveness of statins for primary prevention with mixed findings from studies including participants with widely ranging baseline risks. Decision making for the use of statins should consider individual baseline risk, absolute risk reduction and whether risk reduction justifies potential harms and taking a daily medicine for life.

Trial registration number CRD42017064761.

  • preventive medicine
  • statins
  • overview of systematic reviews
  • cardiovascular medicine
  • primary prevention

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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Footnotes

  • Contributors PB was the lead researcher and involved in the design, implementation and analysis and reporting of the overview. PB conducted the initial search for systematic reviews. PB and AS undertook title and abstract screening, full-text screening, extraction of data and quality assessment. SMS arbitrated any disagreements between PB and AS on inclusion and quality assessment of reviews. JC and SMS provided substantial contributions to the conception, design, analysis and reporting of the work. All authors have read and approved the final manuscript and agree to be accountable for all aspects of the work. PB is the guarantor of this paper.

  • Funding This overview is part of PB’s PhD, which is funded by the SPHeRE HRB structured PhD programme (HRB SPHeRE/2013/1). AS is funded by the Irish Cancer Society Collaborative Cancer Research Centre BREAST-PREDICT (CCRC13GAL). All authors had full access to the data and had final responsibility for the decision to submit this publication.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

  • Patient consent for publication Not required.

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