Clinical Edge

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Efficacy of Statins for Primary Prevention of CVD

Am Heart J; ePub 2019 Jan 10; Yebyo, et al

In a recent meta-analysis that compared the effectiveness and safety of statins for the primary prevention of cardiovascular disease (CVD), all statins demonstrated statistically significant risk reduction of CVD and all-cause mortality while increasing the risk for some harm risks. Researchers performed a random-effect pairwise meta-analysis of all statins as a class and network meta-analysis with 94,283 participants for the specific statins on different benefit and harm outcomes. They found:

  • Statins as a class showed statistically significant risk reductions on non-fatal myocardial infarction (MI), CVD mortality, all-cause mortality, non-fatal stroke, unstable angina, and composite major CV events.
  • Statins increased statistically significantly relative and absolute risks of myopathy, renal dysfunction, and hepatic dysfunction.
  • However, the benefit-harm profile differed by statin type.

Citation:

Yebyo HG, Aschmann HE, Kaufmann M, Puhan MA. Comparative effectiveness and safety of statins as a class and of specific statins for primary prevention of cardiovascular disease: A systematic review, meta-analysis and network meta-analysis of randomized trials with 94,283 participants. [Published online ahead of print January 10, 2019]. Am Heart J. doi:10.1016/j.ahj.2018.12.007.

Commentary:

Preventive therapies balance the efficacy of the therapy with potential risks. A basic tenet of primary prevention notes that many healthy patients exposed to a therapy may never benefit from the treatment. This network meta-analysis evaluated the effect of statins on primary prevention defining the benefit and harm associated with statins. Statins as a class reduced CVD events but showed an increased risk for myopathy, renal and hepatic dysfunction. Atorvastatin and rosuvastatin were the most effective statins in reducing CVR risk. This is not surprising since these 2 statins have the greatest LDL lowering efficacy. Atorvastatin had the best safety profile which is encouraging since this high efficacy statin is commonly prescribed. When prescribing a statin, it is important to understand the absolute benefit and the associated absolute risk. It may be prudent to avoid therapy in patients with a low absolute risk reduction to avoid the more likely development of side effects to the therapy. —Matthew Sorrentino, MD

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