Context Lowering low-density lipoprotein cholesterol (LDL-C) is known to reduce
risk of recurrent coronary heart disease in middle-aged men. However, this
effect has been uncertain in elderly people and women.
Objective To estimate the risk reduction of coronary heart disease and total mortality
associated with statin drug treatment, particularly in elderly individuals
Data Sources Trials published in English-language journals were retrieved by searching
MEDLINE (1966–December 1998), bibliographies, and authors' reference
Study Selection Studies in which participants were randomized to statin or control treatment
for at least 4 years and clinical disease or death was the primary outcome
were included in the meta-analysis (5 of 182 initially identified).
Data Extraction Information on sample size, study drug duration, type and dosage of
statin drug, participant characteristics at baseline, reduction in lipids
during intervention, and outcomes was abstracted independently by 2 authors
(J.H. and S.V.) using a standardized protocol. Disagreements were resolved
Data Synthesis Data from the 5 trials, with 30,817 participants, were included in this
meta-analysis. The mean duration of treatment was 5.4 years. Statin drug treatment
was associated with a 20% reduction in total cholesterol, 28% reduction in
LDL-C, 13% reduction in triglycerides, and 5% increase in high-density lipoprotein
cholesterol. Overall, statin drug treatment reduced risk 31% in major coronary
events (95% confidence interval [CI], 26%-36%) and 21% in all-cause mortality
(95% CI, 14%-28%). The risk reduction in major coronary events was similar
between women (29%; 95% CI, 13%-42%) and men (31%; 95% CI, 26%-35%), and between
persons aged at least 65 years (32%; 95% CI, 23%-39%) and persons younger
than 65 years (31%; 95% CI, 24%-36%).
Conclusions Our meta-analysis indicates that reduction in LDL-C associated with
statin drug treatment decreases the risk of coronary heart disease and all-cause
mortality. The risk reduction was similar for men and women and for elderly
and middle-aged persons.