Evidence-based Use of Statins for Primary Prevention of Cardiovascular Disease

Minder, C. Michael; Blaha, Michael J.; Horne, Aaron; Michos, Erin D.; Kaul, Sanjay; Blumenthal, Roger S.

doi:10.1016/j.amjmed.2011.11.013

Cited by 41 publications

(30 citation statements)

References 32 publications

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“…[26][27][28][29] In our study, use of LLD independently predicted slower progression of carotid atherosclerosis also in participants without prevalent cardiovascular disease. However, the observational study design does not allow inferences about whether the beneficial effect of LLD on atherosclerosis outweighs any possible negative effects of LLD in primary prevention.…”

Section: Discussionmentioning

confidence: 99%

Long-Term Use of Lipid-Lowering Drugs Slows Progression of Carotid Atherosclerosis

Herder

Arntzen²,

Johnsen³

et al. 2013

ATVB

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High cholesterol levels are known risk factors for cardiovascular morbidity, mortality, and atherosclerosis. Since the mid-1990s, statins have been the most important lipidlowering drugs (LLD) in primary and secondary prevention of cardiovascular disease. Statins have reduced the incidence of myocardial infarction and stroke in several randomized clinical trials. [1][2][3][4][5][6][7][8] Carotid intima media thickness (IMT) and plaques assessed by ultrasound are established markers of carotid atherosclerosis, and are used as surrogates for cardiovascular disease. Randomized controlled trials and meta-analyses of randomized controlled trials have shown that statins slow the progression of intima media thickening.9,10 A recent review indicates that statins may have beneficial effects also on plaque progression, but most of the included studies were small observational studies. 9 In a randomized controlled trial of rosuvastatin versus placebo in 492 low-risk patients, plaque progression was significantly lower in the statin group.11 In a study on 4378 patients referred to stroke and atherosclerosis prevention clinics, the annual rate of plaque progression decreased after implementation of a more intensive medical therapy strategy, which included increase of statin to the maximum tolerated dose and addition of ezetimibe to patients already on maximum tolerated statin dose. 12Although randomized clinical trial is gold standard for proving the effect of a given intervention, the generalizability may be limited. There is little knowledge on whether the effect of LLD on atherosclerosis progression seen in randomized clinical trials also applies to other practice settings. The purpose of the present study was to assess the impact of LLD on progression on carotid atherosclerosis in a general population.The Tromsø study is a single-center, longitudinal population study with repeated surveys of the inhabitants of the municipality of Tromsø, Norway. We have repeatedly, over a period of 13 years, obtained information on the use of LLD and cardiovascular risk factors, and measured IMT and total plaque area (TPA) in the right carotid artery.13 This enables assessment of the effect of use of LLD and change in carotid atherosclerosis in unselected subjects belonging to a general population. Materials and MethodsMaterials and Methods are available in the online-only Supplement. Objective-Data on the effect of lipid-lowering drugs (LLD) on carotid atherosclerosis outside clinical trials are limited. The aim of this study was to determine the effect of LLD on change in carotid intima media thickness and total plaque area in a general population. Approach and Results-Subjects were 1532 women and 1442 men who participated in a longitudinal population-based study with ultrasound examination of intima media thickness and total plaque area in the right carotid artery at baseline and after 13 years follow-up. Long-term use of LLD was defined as use for >5 years, any-time use of LLD was defined as use at baseline or at 6 years or at 13 yea...

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Section: Discussionmentioning

confidence: 99%

Long-Term Use of Lipid-Lowering Drugs Slows Progression of Carotid Atherosclerosis

Herder

Arntzen²,

Johnsen³

et al. 2013

ATVB

View full text Add to dashboard Cite

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“…8,[32][33][34] Recent meta-analyses based on both individual patient-level data 4 and study-level reports 5 confirm that allcause mortality benefits of statins in the primary prevention setting are clinically and statistically significant. These recent findings provide supporting evidence for initiating statin therapy in individuals who are at an increased risk of developing cardiovascular disease.…”

Section: Discussionmentioning

confidence: 99%

“…2 Initially focused on secondary prevention, statin therapy has become more common because the limits of treatment have expanded over time to include people at progressively lower risk of developing cardiovascular disease. 8 As the number of individuals eligible for statin therapy continues to increase, 9 the comparative tolerability and harms of different statins warrant further investigation.…”

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confidence: 99%

Comparative Tolerability and Harms of Individual Statins

Naci

Brugts

Ades

2013

Circ: Cardiovascular Quality and Outcomes

250

100

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Background-Our objective was to estimate the comparative harms of individual statins using both placebo-controlled and active-comparator trials. Methods and Results-We systematically reviewed randomized trials evaluating different statins in participants with and without cardiovascular disease. We performed random-effects pairwise and network meta-analyses to quantify the relative harms of individual statins. We included 55 two-armed placebo-controlled and 80 two-or multiarmed active-comparator trials including 246 955 individuals. According to pairwise meta-analyses, individual statins were not different than control in terms of myalgia, creatine kinase elevation, cancer, and discontinuations because of adverse events. Statins as a class resulted in significantly higher odds of diabetes mellitus (odds ratio, 1.09; 95% confidence interval, 1.02-1.16) and transaminase elevations (odds ratio, 1.51; 95% confidence interval, 1.24-1.84) compared with control. When individual statins were compared in network meta-analyses, there were numerous statistically detectable differences, favoring simvastatin and pravastatin. According to dose-level comparisons, individual statins resulted in higher odds of discontinuations with higher doses of atorvastatin and rosuvastatin. Similarly, higher doses of atorvasatin, fluvastatin, lovastatin, and simvastatin were associated with higher odds of transaminase elevations. Simvastatin at its highest doses was associated with creatine kinase elevations (odds ratio, 4.14; 95% credible interval, 1.08-16.24). Meta-regression analyses adjusting for study-level age at baseline, low-density lipoprotein cholesterol level, and publication year did not explain heterogeneity. There was no detectable inconsistency in the network. Conclusions-As

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“…5 Previous treatment guidelines recommended statin therapy in patients with various cardiovascular risks to prevent or reduce the occurrence of future cardiovascular events. 6,7 However, new guidelines recently published by the American College of Cardiology and the American Heart Association (ACC/AHA) expand the recommendation for statin therapy to include patients with an atherosclerotic cardiovascular disease (ASCVD) risk score of ≥ 7.5% (the percentage risk of a heart attack or stroke within the next 10 years). 8 The new guidelines not only address an individual's risk of heart attack but also include, for the first time, the risk of stroke.…”

Section: What Is Already Known About This Subjectmentioning

confidence: 99%