Thirty-five randomised controlled trials involving 74,102 participants were included in this review.
The average Jadad score of the included studies was 4.1.
The incidence of transaminase elevation (reported in 28 studies) was significantly higher in patients receiving statin therapy compared with placebo (RR 1.30, 95% CI: 1.06, 1.59); this was noted particularly in patients receiving fluvastatin and lovastatin. The absolute risk of transaminase elevations was an increase of 4.3 patients per 1,000 treated.
In an analysis of cerivastatin alone compared with placebo, there was a significant increase in the incidence of rhabdomyolysis (RD 12.4, 95% CI: 5.4, 19.3, p<0.01) and transaminase elevations (RD 10.0, 95% CI: 5.1, 14.9, p<0.01).
There was no significant difference in the incidence of myalgias in patients on statin therapy compared with placebo. However, when individual statins were evaluated, there was a statistically significant increase in risk of myalgias in patients that took atorvastatin compared with placebo (RD 31.9, 95% CI: 2.1, 61.6, p=0.04).
There was no significant difference in the incidence of CK elevation, rhabdomyolysis and discontinuation due to adverse events in patients on statin therapy compared with placebo. No significant difference was found in the incidence of myalgias, CK elevation or discontinuation due to adverse events for cerivastatin compared with placebo.
The authors reported that there was no significant evidence of publication bias in pooled analyses or any of the individual listed end points. The funnel plots were not presented in this paper.
Tests for heterogeneity did not reveal any statistically significant differences between the studies.