Low density lipoprotein cholesterol, statins and cardiovascular events: a meta–analysis

摘要

A recent meta–analysis of the Cholesterol Treatment Trialists’ (CTT) Collaboration comes to the clear conclusion that a reduction in LDL–C using statins of 1 mmol/l (39 mg/dl) leads to a decrease in overall mortality by 12%, in coronary mortality by 19% and in the incidence of strokes by 17%, independent of the LDL–C level prior to the start of treatment. We conducted a systematic review retrieving 18 studies with a total of 97 861 participants. Differences in average LDL–C reductions between the intervention and control groups during the follow–up and relative risks according to different clinical endpoints were extracted from the original publications. Metaregression analyses showed that reduction in LDL–C accounted for more than 75% of the variance in risk reductions for overall mortality and cardiovascular endpoints. On the basis of our estimates, a reduction in LDL–C of 1 mmol/l (39 mg/dl) leads to reductions in overall mortality, coronary mortality, incidence of non–fatal myocardial infarction, the combination of coronary mortality and non–fatal myocardial infarction, stroke and any vascular event by 15% (95% CI: 11–20%), 24% (95% CI: 20–28%), 27% (95% CI: 20–32%), 25% (95% CI: 22–29%), 24% (18–29%) and 22% (95% CI: 19–26%), respectively. We conclude that the extent to which statins lower LDL–C is strongly related to the improvement of clinical outcomes achieved by this class of drugs.