Is intensive LDL-cholesterol lowering beneficial and safe?

摘要

Statins have been in clinical use for two decades. Since the pioneering Scandinavian Simvastatin Survival Study (4S) trial, which showed that simvastatin reduced mortality in patients with a high cardiovascular risk, many large outcome trials of statins have been done. Systematic review of these studies is thus important. Unlike conventional meta-analyses, the Cholesterol Treatment Trialists' (CTT) Collaborators used individual patients' data rather than summary data. Although individual data give more scope for the analysis of subgroups and separate endpoints, only studies involved in the collaboration can be included. Now in The Lancet, the CTT Collaboration report their latest analysis which included studies such as SEARCH, published simultaneously. The investigators first updated estimates of the treatment effect of statins versus placebo, and then considered the. incremental benefits and safety of more-intensive lipid lowering compared with less-intensive treatments. They showed that more-intensive therapy produces further reductions in each category of major vascular events (coronary death or non-fatal myocardial infarction, coronary revascularisation, and ischaemic stroke).