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*Meta-Analyses  of Statin Therapy for Primary Prevention Do Not Answer Key
Questions:  An Empirical Appraisal of 5 Years of Statin Meta-Analyses*
http://link.springer.com/article/10.1007/s40256-015-0139-y


*Although meta-analyses of statins in primary prevention are designed to
provide doctors and patients with better evidence about the risks and
potential benefits of treatment, they may ignore important
patient-centered outcomes and concerns. We examined all meta-analyses of
statins for primary prevention over the last 5 years. We assessed  whether
each meta-analysis addressed five key points: whether authors  examined
endpoints based on the use of statin therapy, and not  stratified by
low-density lipoprotein reduction; whether authors  included only studies
of statin versus placebo, and not varying doses or  brands of statin;
whether authors considered commonly cited harms;  whether secondary
prevention patients were excluded; and, whether  overall mortality was
examined. We examined 189 articles to identify 24  meta-analyses of statins
that made claims regarding primary prevention.  Six studies (25 %) reported
outcomes as a function of reduction in serum  lipid levels rather than
treatment received. Seven studies (29 %)  included trials of high-dose
versus low-dose statin in their analysis.  Five studies (21 %) did not
examine all-cause mortality. The majority of  studies (n = 21, 88 %) failed
to  exclude patients with known cardiovascular disease, and 22 (92 %)
studies failed to assess two of three common safety concerns.
Nevertheless, most (n = 20, 83 %)  meta-analyses supported the use of
statins in primary prevention. Based  on our findings, we conclude that
most recent meta-analyses of statins  for primary prevention do not
adequately address the question they seek  to answer.*
-un saludo juan gérvas @JuanGrvas

2017-01-17 0:28 GMT+01:00 Brian Alper MD <[log in to unmask]>:

> I don’t expect the NNT’s below to be accurate if derived from the Lancet
> 2005 review – the meta-analysis by the CTT Collaborators reported is on the
> risk reductions “per mmol/L LDL cholesterol reduction” and not an estimate
> of statin vs. placebo effects such that the NNT would represent the number
> needed to treat with statins to have the benefits.
>
>
>
> Using evidence more specific to statins vs. placebo for the population of
> patients with heart disease the NNT results are actually better (lower NNT
> numbers, larger estimated absolute risk reductions) if you use either of:
>
>
>
> Wilt TJ et al. Effectiveness of statin therapy in adults with coronary
> heart disease. Arch Intern Med 2004 Jul 12;164(13):1427-36
> https://www.ncbi.nlm.nih.gov/pubmed/15249352?dopt=Abstract
>
>
>
> Gutierrez J et al. Statin therapy in the prevention of recurrent
> cardiovascular events: a sex-based meta-analysis. Arch Intern Med 2012 Jun
> 25;172(12):909-19 https://www.ncbi.nlm.nih.gov/
> pubmed/22732744?dopt=Abstract
>
>
>
>
>
> *Brian S. Alper, MD, MSPH, FAAFP*
>
> Founder of DynaMed <http://www.dynamed.com/>
> Vice President of Innovations and Evidence-Based Medicine Development, EBSCO
> Health <http://health.ebsco.com>
> Office: 978-356-6500 x2749 <(978)%20356-6500> | Cell: 978-804-8719
> <(978)%20804-8719>
>
> Mission: Provide the most useful information for healthcare decision-making
>
> *"It only takes a pebble to start an avalanche."*
>
> Thought for today: Whether positive or negative occurs let’s DEVELOP for
> the positive <https://www.linkedin.com/pulse/develop-brian-alper> … [image:
> http://cdn2.hubspot.net/hubfs/184235/dev_images/signature_app/linkedin_sig.png]
> <https://www.linkedin.com/pulse/catalog-brian-alper> [image:
> http://cdn2.hubspot.net/hubfs/184235/dev_images/signature_app/twitter_sig.png]
> <https://twitter.com/brianalpermd>
>
> [image: DMP_Logo_V1] <http://www.dynamed.com/>
>
> [image: Marketing:Creative Services:EBSCO
> Health:_Campaigns:KLAS:Emails:_Email
> Signature:DMP:DynaMed_KLAS_Signature_1216_2
> Folder:DMP_KLAS_EmailSignature.jpg]
>
>
>
> *From:* Evidence based health (EBH) [mailto:EVIDENCE-BASED-HEALTH@
> JISCMAIL.AC.UK] *On Behalf Of *Moacyr Roberto Cuce Nobre
> *Sent:* Monday, January 16, 2017 6:14 PM
> *To:* [log in to unmask]
> *Subject:* Re: absolute benefit of statins
>
>
>
> Hi Jeremy
>
>
>
> Statins Given for 5 Years for Heart Disease Prevention (With Known Heart
> Disease)
>
>
>
> Benefits in NNT
>
>
>
> 1 in 83 were helped (life saved)
>
> 1 in 39 were helped (preventing non-fatal heart attack)
>
> 1 in 125 were helped (preventing stroke)
>
>
>
> Harms in NNT
>
>
>
> 1 in 50 were harmed (develop diabetes*)
>
> 1 in 10 were harmed (muscle damage)
>
>
>
> Details for this Review
>
>
>
> CTT Collaborators. Efﬁcacy and safety of cholesterol-lowering treatment:
> prospective meta-analysis of data from 90 056 participants in 14 randomised
> trials of statins. Lancet. 2005; 366: 1267-1278.
>
>
>
> http://www.thennt.com/nnt/statins-for-heart-disease-
> prevention-with-known-heart-disease/
>
>
>
> Cheers
>
> --
> Moacyr
>
> _______________________________________
> Moacyr Roberto Cuce Nobre, MD, MS, PhD
> Equipe de Epidemiologia Clínica e Apoio à Pesquisa
> Instituto do Coração (InCor) Hospital das Clínicas
> Faculdade de Medicina da Universidade de São Paulo
> 55 11 2661 5941 (fone/fax)
> 55 11 991 331 009 (celular)
>
>
> ------------------------------
>
> *De: *"Jeremy Howick" <[log in to unmask]>
> *Para: *[log in to unmask]
> *Enviadas: *Segunda-feira, 16 de Janeiro de 2017 14:33:40
> *Assunto: *absolute benefit of statins
>
> Does anyone have any information about the ABSOLUTE RISK REDUCTION of
> statins for high risk individuals?
>
>
>
> I realise that ‘high risk’ is classified a number of ways, as long as it
> is specified I don’t might which classification is used.
>
>
>
> Thanks in advance!
>
>
>
> Jeremy
>
> *[image: cid:image002.jpg@01D16B2F.E8A8B320]*
>
>
>
> T: +44 (0)1865 289 258 <+44%201865%20289258> E: [log in to unmask]
> <[log in to unmask]>
>
> http://www.phc.ox.ac.uk/team/jeremy-howick
>
>
>
> Nuffield Department of Primary Care Health Sciences, University of Oxford
> Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock
> Road, Oxford, OX2 6GG
>
>
>