A new meta-analysis has confirmed that statins improve survival and reduce the risk of major cardiovascular events in patients who have risk factors but who do not have established cardiovascular disease.
The meta-analysis, published in the British Medical Journal (BMJ 2009;338:b2376) included 10 primary prevention trials of statins versus placebo including a total of 70,388 people. The trials included were: WOSCOPS, AFCAPS/TexCAPS, PROSPER, ALLHAT-LLT, ASCOT-LLA, HPS, CARDS, ASPEN, MEGA, and JUPITER.
Results showed significant reductions in all-cause mortality, major coronary events and major cerebrovascular events with statins versus placebo (see table 1), regardless of age, gender, or diabetes status.
Despite these positive findings, the authors say that the absolute overall benefit in the current study population would be less than 1%, and significant numbers of people would need to be treated to prevent one event. They add that while it is not possible to define one group of people who would benefit most from statin use, older men (>65 years) with risk factors or older women with diabetes and risk factors constitute the highest-risk group and that it is likely that a considerable number of such people would benefit from long-term statin use at reasonable costs
Because the occurrence of cancer was increased in the PROSPER trial of statins in elderly patients, the authors of the current meta-analysis examined cancer rates and found no increase in people taking statins. But they caution that longer follow-up is needed to rule out increases in new cancer events over time, which they say is critical when statins are used in primary prevention. And they add that concerns might remain about a possible higher risk of cancer in elderly patients.