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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
Vice President of Innovations and Evidence-Based Medicine Development, EBSCO Health
Office: 978-356-6500 x2749 | Cell: 978-804-8719

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 …

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: EVIDENCE-BASED-HEALTH@JISCMAIL.AC.UK
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: EVIDENCE-BASED-HEALTH@JISCMAIL.AC.UK
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

T: +44 (0)1865 289 258 E: [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