C. Heneghan Considerable uncertainty remains in evidence for primary prevention of cardiovascular disease [editorial]. The Cochrane Library 2011 (January 19)‘It’s not that simple extrapolation from studies of effects in people with a history of heart disease,’ said lead researcher Fiona Taylor, from the Cochrane Heart Group at the London School of Hygiene and Tropical Medicine, London, United Kingdom. ‘This review highlights significant gaps in our knowledge of the effects of statins in people with no history of cardiovascular disease. The decision to prescribe statins in this group should not be taken lightly.’
Ebrahim S, M Taylor, K. Ward, Beswick A, Burke M, Davey Smith G. multiple risk factor interventions for primary prevention. Cochrane Database of Systematic Reviews 2011, Issue 1. Art. DOI: 10.1002/14651858.CD001561.pub3
The researchers examined data from 14 studies involving 34 272 patients. Results in patients treated with statins were compared with results of patients given placebo or usual care. The combined data from eight studies of 28 161 patients who provided data on deaths from all causes showed that statins reduced the risk of dying of 9-8 deaths per 1000 people treated with statins each year. Statins reduce fatal and nonfatal events, including revascularization and surgery, and levels of blood cholesterol.
However, the researchers say the results of their study are limited by light, potentially bringing partial and selective, and that particular attention should be given to individual risk profiles of patients before prescribing statins.
There is insufficient evidence to recommend the widespread use of statins in people with no history of heart disease, according to a new Cochrane Systematic Review. The researchers say that statins should be prescribed with caution in patients at low risk of cardiovascular disease (CVD).
Cardiovascular disease is the most common cause of death, almost one third of deaths worldwide. Cholesterol-lowering statins are the first line of treatment for cardiac patients, and the benefits are well established. However, there is less evidence that statins are useful in the prevention of heart disease in those who have no history of cardiovascular disease. Since little has been shown to increase the risk of death from other causes, statins can cause more harm than good in some patients.
The researchers stress that all but one of the tests examined industry-sponsored. ‘We know that studies sponsored by industry are more likely to report positive results for drugs against placebo, so we must be careful in interpreting these results,’ said Taylor. ‘The numbers eligible for treatment with statins are potentially very sure that there might be motivated, for example, to stop testing earlier if the preliminary results support their use.’