Articles found in English, Spanish, Italian, German, French using MEDLARS and Current Contents, up to April 1997 (search terms: anticholesterolemic agents, pravastatin, lovastatin, fluvastatin, atorvastatin, cerivastatin, simvastatin and human trials ) and manual searching of bibliographies of retrieved articles, and contacting several investigators to identify any new or ongoing trials.

Selection criteria: as above
Appraisal criteria: Jadad's instrument by two independent reviewers
Articles excluded if:

Seventeen trials with 21,303 patients were included.
No heterogeneity was found.

The evidence

Myocardial infarction: statins decrease mortality.

Clinical bottom line (level 1a)

  1. Patients with who are given statin treatment for cholesterol regulation, are less likely to die than those given placebo (NNT = 72 at unknown) .
  2. Patients given statin treatment are less likely to have a fatal myocardial infarction (NNT = 160 at years) , or a nonfatal myocardial infarction (NNT = 50 at years) .
  3. Patients given statins are less likely to have a nonfatal stroke (NNT = 150 at unknown) , but there is no clear effect on fatal strokes.
Ross et al: Archives of Internal Medicine 1999; 159: 1793-1802
Expires March 2003

The study

Systematic review of randomised controlled trials of
  • Patients: requiring statins for cholesterol regulation
  • Intervention: statins compared with placebo
  • Outcome: mortality, MI or stroke


    • Articles found in English, Spanish, Italian, German, French using MEDLARS and Current Contents, up to April 1997 (search terms: anticholesterolemic agents, pravastatin, lovastatin, fluvastatin, atorvastatin, cerivastatin, simvastatin and human trials ) and manual searching of bibliographies of retrieved articles, and contacting several investigators to identify any new or ongoing trials.

    Selection criteria: as above
    Appraisal criteria: Jadad's instrument by two independent reviewers
    Articles excluded if:
    • active drug as control
    • <1 year long
    • <11 patients


    Seventeen trials with 21,303 patients were included.
    No heterogeneity was found.

    The evidence

    Outcome Time to outcome CER OR
    (95% CI)    		 NNT
    (95% CI)
    all cause mortality unknown 639/10199
    (6.27%)    		 0.76
    (0.67 to 0.86)     		72
    (52 to 120)
    fatal myocardial infarction unknown 168/10287
    (1.60%)    		 0.61
    (0.48 to 0.78)     		160
    (120 to 290)
    fatal stroke unknown 97/9633
    (1.00%)    		 0.77
    (0.57 to 1.04)     		440
    (NNT = 230 to infinity;
    NNH = 2530 to infinity)
    nonfatal myocardial infarction unknown 710/10136
    (7.00%)    		 0.69
    (0.57 to 0.77)     		48
    (35 to 66)
    nonfatal stroke unknown 159/7211
    (2.20%)    		 0.69
    (0.54 to 0.88)     		150
    (100 to 390)

    • No significant difference between type of statin noted.

    Comments

    1. Non-standard times of outcomes makes NNTs less clear.

    Citation

    1. Ross SD, Allen IE, Connelly JE, et al: Clinical outcomes in statin treatment trials: A meta-analysis. Archives of Internal Medicine 1999; 159: 1793-1802
    Contributor: Clare Wotton and Bob Phillips, January 2000
    Reviewer: Dwight Peretz

    Clinical Question.
    Patient hypercholesterolaemia
    Intervention or Exposure statins
    Comparison no statins
    Outcome mortality, MI and stroke
Outcome Time to outcome CER OR
(95% CI)		 NNT
(95% CI)
all cause mortality unknown 639/10199
(6.27%)		 0.76
(0.67 to 0.86) 		72
(52 to 120)
fatal myocardial infarction unknown 168/10287
(1.60%)		 0.61
(0.48 to 0.78) 		160
(120 to 290)
fatal stroke unknown 97/9633
(1.00%)		 0.77
(0.57 to 1.04) 		440
(NNT = 230 to infinity;
NNH = 2530 to infinity)
nonfatal myocardial infarction unknown 710/10136
(7.00%)		 0.69
(0.57 to 0.77) 		48
(35 to 66)
nonfatal stroke unknown 159/7211
(2.20%)		 0.69
(0.54 to 0.88) 		150
(100 to 390)

Comments

  1. Non-standard times of outcomes makes NNTs less clear.

Citation

  1. Ross SD, Allen IE, Connelly JE, et al: Clinical outcomes in statin treatment trials: A meta-analysis. Archives of Internal Medicine 1999; 159: 1793-1802
Contributor: Clare Wotton and Bob Phillips, January 2000
Reviewer: Dwight Peretz

Clinical Question.
Patient hypercholesterolaemia
Intervention or Exposure statins
Comparison no statins
Outcome mortality, MI and stroke