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Statins for the primary prevention of cardiovascular disease

Comment by Monique Verschuren, EACPR Prevention Epidemiology and Population Science Section

Statins for the primary prevention of cardiovascular disease
Taylor F, Ward K, Moore THM et al
Cochrane Database of Systematic Reviews 2011, Issue 1. Art. No.: CD004816.

Prevention


Statins are known to lower the risk of cardiovascular diseases (CVD). The majority of trials has focused on the use of statins for secondary prevention, but the benefits of using statins in primary prevention are less clear. This review has identified 14 randomised controlled trials in persons without a history of CVD, including almost 35,000 persons.

The conclusion is that also in primary prevention, a significant lowering of cardiovascular endpoints is observed: a 17% reduction in all-cause mortality, a 30% reduction in the combined endpoint of fatal and non-fatal CVD and a 34% reduction in revascularization rates. No adverse effects were observed. Only one trial reported on costs, and no trial reported on quality of life.

Therefore, information on cost-effectiveness of treating individuals without a history of CVD is still lacking. It also has to be noted that the majority of the participants in these trials were white, male and middle-aged. Therefore, we need to be cautious in applying the results to older people, who may be at greater risk of side effects, and to women, who are at lower risk of CVD events.