Statins for people at low risk of cardiovascular disease

摘要

We disagree with the conclusions of the Cholesterol Treatment Trialists' (CTT) Collaborators (Aug 11, p 58I) for several reasons.First, the relevance of the results is limited to patients with the chosen LDL cholesterol response (1 mmol/L reduction)-an unpredictable variable that cannot be used to suggest that populations will or will not benefit. Moreover, regressing post-hoc against a specific LDL cholesterol reduction permits confounding by lurking variables that could advantage the statin groups. When randomisation equivalence is maintained with unadjusted comparisons, analyses have yet to find a mortality benefit from statins in primary prevention.Second, the CTT Collaborators are notably selective in their handling of subgroup analyses, prominently reporting that low-risk patients with no vascular disease seem to show a mortality benefit in the statin group. They do not discuss, however, the absence of effect on coronary mortality, stroke mortality, other cardiac mortality, vascular mortality, non-vascular mortality, or all-cause mortality in any other low-risk subgroup; including those with vascular disease. The selected subgroup is likely to be anomalous.