Seven RCTs (50,972 participants) were included in each of the meta-analyses. Mean follow-up ranged from one to 4.9 years. Two trials were placebo controlled.
Stroke events were significantly reduced by intensive lipid lowering with statins (OR 0.80, 95% CI 0.71 to 0.89), as were major coronary events (OR 0.74, 95% CI 0.65 to 0.83) and mortality from cardiovascular or coronary heart disease (OR 0.84, 95% CI 0.74 to 0.95). All results remained statistically significant following removal of trials in the sensitivity analysis.
There was no statistically significant difference between groups in relation to treatment discontinuation. Liver enzyme elevation was significantly increased as a result of intensive lipid lowering (OR 3.96, 95% CI 2.08 to 7.53).
When all studies were included, significant heterogeneity was found for major coronary events, liver enzyme elevation and treatment discontinuation. There was no statistically significant heterogeneity when the placebo-controlled trials were removed.