There were 69,511 participants in the 25 studies included in the review. There were 19 placebo-controlled studies (n=52,782), 3 studies of statin versus usual care (n=12,181), one of aggressive versus moderate dose of lovastatin, one of statin versus statin (simvastatin versus atorvastatin), one of statin versus PCI, and one of statin for participants with acute coronary syndromes (ACS) (n=3,076). There were 42,173 participants with overt CHD and 10,389 participants at high risk of CHD.
Statins versus placebo.
The pooled analyses showed statins reduced CHD mortality or nonfatal MI by 25% (RR 0.75, 95% confidence interval, CI: 0.71, 0.79) with an absolute risk reduction (ARR) of 3.8%. Statins also reduced all-cause mortality by 16% (RR 0.84, 95% CI: 0.79, 0.89; ARR 1.8%) and CHD mortality by 23% (RR 0.77, 95% CI: 0.71, 0.83; ARR 1.4%). The reduction in risk for these outcomes was consistent in sensitivity analyses of studies of patients with ACS, patients with PCI, and patients with high versus low use of concomitant cardiovascular medications. The authors reported that there were similar reductions in risk for outcomes of revascularisation, cerebrovascular events, and major coronary or vascular events, although no data were presented.
In women (6 studies, 7,920 participants), statins reduced CHD mortality or nonfatal MI by 25% (RR 0.75, 95% CI: 0.65, 0.86; ARR 2.8%). All-cause or CHD mortality was only reported for women in 2 studies, and no significant difference was seen.
In older people (6 studies), statins reduced CHD death or nonfatal MI (16,785 participants) by 24% (RR 0.76, 95% CI: 0.71, 0.81; ARR 4.2%), all cause mortality (4,941 participants) by 15% (RR 0.85, 95% CI: 0.73, 0.99; ARR 1.8%) and CHD death (3,942 participants) by 35% (RR 0.65, 95% CI: 0. 49, 0.86; ARR 2.1%).
There were no results presented according to race as few studies provided data.
In studies of people with previous revascularisation (3,206 participants), statins reduced CHD mortality or nonfatal MI by 33% (RR 0.67, 95% CI: 0.48, 0.93; ARR 1.7%).
Further results were presented in the paper.
Statins versus usual care (3 studies, 12,081 participants).
Compared with usual care, statins reduced CHD mortality by 31% (RR 0.69, 95% CI: 0.47, 1.01). There were no significant reductions in CHD mortality and nonfatal MI (1 study 1,475 participants) or all-cause mortality (2 studies, 3,075 participants).