The efficacy and safety of intensive statin therapy: a meta-analysis of randomized trials

Josan, Kiranbir; Majumdar, Sumit R.; McAlister, Finlay A.

doi:10.1503/cmaj.070675

Cited by 161 publications

(104 citation statements)

References 38 publications

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“…Several meta-analyses provide evidence that high-dose statin therapy, as opposed to moderate doses, provides additional protection against cardiovascular events, but not all-cause mortality, in secondary prevention, 85,92,93 but no such benefit has been found in primary prevention. 61 The benefits of exercise extend equally to reductions in CVD and mortality, with a consistent dose response (Table 5). Variable but predictable risk reduction occured in primary care meta-analyses, with estimates ranging from 11% to 57%.…”

Section: Comparing the Benefits Of Drug Or Exercise Interventions Usementioning

confidence: 89%

“…36 The only existing RCT comparing myalgia at high and low doses of statins actually showed no difference. 60 Since there is no clinical trial-based evidence for an additional benefit of high-dose statins against mortality in primary prevention, 61 and since no study has established valid low-density lipoprotein targets, 1 it would seem reasonable to be content with a low dose if a statin is to be used. 3.…”

Section: Mitigation Of Statin Myopathymentioning

confidence: 99%

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Statin Therapy as Primary Prevention in Exercising Adults: Best Evidence for Avoiding Myalgia

Bosomworth

2016

The Journal of the American Board of Family Medicine

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Introduction: This review aims to determine whether active adults who begin statins and develop myalgia reduce or stop activity to become less symptomatic. If this occurs, strategies to mitigate symptoms are explored. Should these strategies fail, the question of whether exercise is an adequate alternative to statin therapy is addressed.Methods: PubMed, Google Scholar, and the Cochrane Database were searched with keywords designed to retrieve information on statin myopathy in exercising adults.Results: Statins are well tolerated by most people who exercise; however, caution is warranted in those who exercise at high levels, in the elderly, and in those receiving high-dose therapy. Several strategies improve statin tolerance while maintaining exercise levels, based on low-quality evidence.

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Section: Comparing the Benefits Of Drug Or Exercise Interventions Usementioning

confidence: 89%

Section: Mitigation Of Statin Myopathymentioning

confidence: 99%

Statin Therapy as Primary Prevention in Exercising Adults: Best Evidence for Avoiding Myalgia

Bosomworth

2016

The Journal of the American Board of Family Medicine

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“…A meta-analysis of seven trials (involving 29,395 patients with CAD) 67 comparing intensive statin therapy with less intensive statin therapy found that more intensive regimens (atorvastatin 80 mg/day or simvastatin 80 mg/day) were associated with higher levels of aminotransferases (1.5% versus 0.4%; OR 4.14; 95% CI 2.30 to 7.44), myalgia (3.3% versus 2.8%; OR 1.26; 95% CI 0.98 to 1.63), myopathy (2.2% versus 1.8%; OR 1.91; 95% CI 0.11 to 32.13) and rhabdomyolysis (0.05% versus 0.04%; OR 0.97; 95% CI 0.29 to 3.24) than less intensive regimens (atorvastatin 10 mg/day, lovastatin 5 mg/ day, pravastatin 40 mg/day, simvastatin 20 mg/ day). Similar observations were reported in a metaanalysis by Silva et al 68 This meta-analysis included four trials (all of which were included in the aforementioned meta-analysis) comprising 27,548 In addition to these meta-analyses several other pooled analyses were identified.…”

Section: Intensive-dose Statinsmentioning

confidence: 99%

Early high-dose lipid-lowering therapy to avoid cardiac events: a systematic review and economic evaluation

Ara

Pandor²,

Stevens³

et al. 2009

Health Technol Assess

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How to obtain copies of this and other HTA programme reports An electronic version of this publication, in Adobe Acrobat format, is available for downloading free of charge for personal use from the HTA website (www.hta.ac.uk). A fully searchable CD-ROM is also available (see below).Printed copies of HTA monographs cost £20 each (post and packing free in the UK) to both public and private sector purchasers from our Despatch Agents.Non-UK purchasers will have to pay a small fee for post and packing. For European countries the cost is £2 per monograph and for the rest of the world £3 per monograph.You can order HTA monographs from our Despatch Agents:-fax (with credit card or official purchase order) -post (with credit card or official purchase order or cheque) -phone during office hours (credit card only).Additionally the HTA website allows you either to pay securely by credit card or to print out your order and then post or fax it. Contact details are as follows: Payment methods Paying by chequeIf you pay by cheque, the cheque must be in pounds sterling, made payable to Direct Mail Works Ltd and drawn on a bank with a UK address. Paying by credit cardThe following cards are accepted by phone, fax, post or via the website ordering pages: Delta, Eurocard, Mastercard, Solo, Switch and Visa. We advise against sending credit card details in a plain email.Paying by official purchase order You can post or fax these, but they must be from public bodies (i.e. NHS or universities) within the UK. We cannot at present accept purchase orders from commercial companies or from outside the UK. How do I get a copy of HTA on CD?Please use the form on the HTA website (www.hta.ac.uk/htacd.htm). Or contact Direct Mail Works (see contact details above) by email, post, fax or phone. HTA on CD is currently free of charge worldwide.The website also provides information about the HTA programme and lists the membership of the various committees. HTA NIHR Health Technology Assessment programmeT he Health Technology Assessment (HTA) programme, part of the National Institute for Health Research (NIHR), was set up in 1993. It produces high-quality research information on the effectiveness, costs and broader impact of health technologies for those who use, manage and provide care in the NHS. 'Health technologies' are broadly defined as all interventions used to promote health, prevent and treat disease, and improve rehabilitation and long-term care. The research findings from the HTA programme directly influence decision-making bodies such as the National Institute for Health and Clinical Excellence (NICE) and the National Screening Committee (NSC). HTA findings also help to improve the quality of clinical practice in the NHS indirectly in that they form a key component of the 'National Knowledge Service'. The HTA programme is needs led in that it fills gaps in the evidence needed by the NHS. There are three routes to the start of projects. First is the commissioned route. Suggestions for research are actively sought from people working in t...

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“…Six months after cardiac catheterization, only half of the participants were taking triple therapy (statin, an antiplatelet agent and an angiotensin-converting-enzyme inhibitor), and, although over 80% were taking statins, their dosages were still low relative to the doses in clinical trials. 10,14 As a result, less than half of the participants had attained the guideline-recommended LDL targets. Thus, our inability to show a statistically significant benefit over control cannot merely be attributed to a ceiling effect.…”

Section: Discussionmentioning

confidence: 99%

The Enhancing Secondary Prevention in Coronary Artery Disease trial

McAlister¹,

Fradette²,

Majumdar³

et al. 2009

Canadian Medical Association Journal

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Background: Proven efficacious therapies are sometimes underused in patients with chronic cardiac conditions, resulting in suboptimal outcomes. We evaluated whether evidence summaries, which were either unsigned or signed by local opinion leaders, improved the quality of secondary prevention care delivered by primary care physicians of patients with coronary artery disease. Methods:We performed a randomized trial, clustered at the level of the primary care physician, with 3 study arms: control, unsigned statements or opinion leader statements. The statements were faxed to primary care physicians of adults with coronary artery disease at the time of elective cardiac catheterization. The primary outcome was improvement in statin management (initiation or dose increase) 6 months after catheterization. Results:We enrolled 480 adults from 252 practices. Although statin use was high at baseline (n = 316 [66%]), most patients were taking a low dose (mean 32% of the guideline-recommended dose), and their low-density lipoprotein (LDL) cholesterol levels were elevated (mean 3.09 mmol/L). Six months after catheterization, statin management had improved in 79 of 157 patients (50%) in the control arm, 85 of 158 (54%) patients in the unsigned statement group (adjusted odds ratio [OR] 1.18, 95% CI 0.71-1.94, p = 0.52) and 99 of 165 (60%) patients in the opinion leader statement group (adjusted OR 1.51, 95% CI 0.94-2.42, p = 0.09). The mean fasting LDL cholesterol levels after 6 months were similar in all 3 study arms: 2.35 (standard deviation [SD] 0.86) mmol/L in the control arm compared with 2.24 (SD 0.73) among those in the opinion leader group (p = 0.48) and 2.19 (SD 0.68) in the unsigned statement group (p = 0.32).Interpretation: Faxed evidence reminders for primary care physicians, even when endorsed by local opinion leaders, were insufficient to optimize the quality of care for adults with coronary artery disease. ClinicalTrials.gov trial register no. NCT00175240. AbstractPreviously published at www.cmaj.ca

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The efficacy and safety of intensive statin therapy: a meta-analysis of randomized trials

Cited by 161 publications

References 38 publications

Statin Therapy as Primary Prevention in Exercising Adults: Best Evidence for Avoiding Myalgia

Statin Therapy as Primary Prevention in Exercising Adults: Best Evidence for Avoiding Myalgia

Early high-dose lipid-lowering therapy to avoid cardiac events: a systematic review and economic evaluation

The Enhancing Secondary Prevention in Coronary Artery Disease trial

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