| Abstract |
OBJECTIVES:
This study sought to determine whether statins reduce coronary heart disease
(CHD) risk more than other interventions that also primarily lower low-density
lipoprotein cholesterol (LDL-C).
BACKGROUND: Statins have anti-inflammatory, immunomodulatory, antithrombotic,
vascular, and other non-LDL-C-lowering effects. It is unclear whether
these pleiotropic effects contribute to cardiovascular risk reduction
beyond that expected from LDL-C reduction alone.
METHODS: Trials published in English language journals were retrieved
by searching Medline (1966 to October 2004), bibliographies, and the author's
reference files. Randomized, placebo-controlled trials of interventions
to primarily lower LDL-C of three or more years' duration in which clinical
disease or death were primary outcomes were used. Information on sample
size, treatment type and duration, participant characteristics at baseline,
reduction in lipids, and outcome was independently abstracted by two authors
(J.R. and N.M.) using a standardized protocol. Data from 5 diet, 3 bile
acid sequestrant, 1 surgery, and 10 statin trials, with 81,859 participants,
were included in the CHD meta-regression analysis.
RESULTS: The regression lines for non-statin and statin trials were similar
and consistent with a one-to-one relationship between LDL-C lowering and
CHD and stroke reduction over five years of treatment.
CONCLUSIONS: The pleiotropic effects of statins do not seem to contribute
an additional cardiovascular risk reduction benefit beyond that expected
from the degree of LDL-C lowering observed in other trials that primarily
lowered LDL-C.
|
