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Statins and All-Cause Mortality in High-Risk Primary Prevention of Patients With Cardiovascular Risk Factors

Statins and All-Cause Mortality in High-Risk Primary Prevention of Patients With Cardiovascular... As pointed out in the meta-analysis by Ray et al,1 as well as by others,2-5 the effectiveness of a statin is much more dependant on the specific clinical profile of the individual man or woman considered for treatment, and this therefore relates directly to the selection criteria of the study participants in the individual intervention trials. The composition of the components of cardiovascular risk profile—to name just one relevant factor—will have significant bearing on the effectiveness of the drug in a high-risk subject considered for treatment. For instance, an elderly subject at risk because of hypertension will benefit less from a statin than a normotensive middle-aged person with an unfavorable lipid profile. A matter that Ray et al1 insufficiently address is the effect of statins on nonfatal cardiovascular events in primary prevention. We, as well as others, have shown that these are considerable. Rates of myocardial infarction, stroke, and revascularizations are all typically reduced by at least 30%.2,4,5 It is hard to imagine that the reduction in such critical clinical events would have no influence on the final outcome with longer follow-up. Correspondence: Dr Brugts, Department of Cardiology, Erasmus Medical Centre Thoraxcenter, ‘s Gravendijkwal 230, 3015 GE Rotterdam, the Netherlands (j.brugts@erasmusmc.nl). References 1. Ray KKSeshasai SRErqou S et al. Statins and all-cause mortality in high-risk primary prevention: a meta-analysis of 11 randomized controlled trials involving 65,229 participants. Arch Intern Med 2010;170 (12) 1024- 1031PubMedGoogle Scholar 2. Brugts JJYetgin THoeks SE et al. The benefits of statins in people without established cardiovascular disease but with cardiovascular risk factors: meta-analysis of randomised controlled trials. BMJ 2009;338b2376PubMed10.1136/bmj.b2376Google Scholar 3. Mills EJRachlis BWu PDevereaux PJArora PPerri D Primary prevention of cardiovascular mortality and events with statin treatments: a network meta-analysis involving more than 65,000 patients. J Am Coll Cardiol 2008;52 (22) 1769- 1781PubMedGoogle Scholar 4. Thavendiranathan PBagai ABrookhart MAChoudhry NK Primary prevention of cardiovascular diseases with statin therapy: a meta-analysis of randomized controlled trials. Arch Intern Med 2006;166 (21) 2307- 2313PubMedGoogle Scholar 5. Ridker PMDanielson EFonseca FA et al. JUPITER Study Group, Rosuvastatin to prevent vascular events in men and women with elevated C-reactive protein. N Engl J Med 2008;359 (21) 2195- 2207PubMedGoogle Scholar http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Statins and All-Cause Mortality in High-Risk Primary Prevention of Patients With Cardiovascular Risk Factors

Statins and All-Cause Mortality in High-Risk Primary Prevention of Patients With Cardiovascular Risk Factors

Abstract

As pointed out in the meta-analysis by Ray et al,1 as well as by others,2-5 the effectiveness of a statin is much more dependant on the specific clinical profile of the individual man or woman considered for treatment, and this therefore relates directly to the selection criteria of the study participants in the individual intervention trials. The composition of the components of cardiovascular risk profile—to name just one relevant factor—will have significant bearing on the...
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Publisher
American Medical Association
Copyright
Copyright © 2010 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinternmed.2010.455
Publisher site
See Article on Publisher Site

Abstract

As pointed out in the meta-analysis by Ray et al,1 as well as by others,2-5 the effectiveness of a statin is much more dependant on the specific clinical profile of the individual man or woman considered for treatment, and this therefore relates directly to the selection criteria of the study participants in the individual intervention trials. The composition of the components of cardiovascular risk profile—to name just one relevant factor—will have significant bearing on the effectiveness of the drug in a high-risk subject considered for treatment. For instance, an elderly subject at risk because of hypertension will benefit less from a statin than a normotensive middle-aged person with an unfavorable lipid profile. A matter that Ray et al1 insufficiently address is the effect of statins on nonfatal cardiovascular events in primary prevention. We, as well as others, have shown that these are considerable. Rates of myocardial infarction, stroke, and revascularizations are all typically reduced by at least 30%.2,4,5 It is hard to imagine that the reduction in such critical clinical events would have no influence on the final outcome with longer follow-up. Correspondence: Dr Brugts, Department of Cardiology, Erasmus Medical Centre Thoraxcenter, ‘s Gravendijkwal 230, 3015 GE Rotterdam, the Netherlands (j.brugts@erasmusmc.nl). References 1. Ray KKSeshasai SRErqou S et al. Statins and all-cause mortality in high-risk primary prevention: a meta-analysis of 11 randomized controlled trials involving 65,229 participants. Arch Intern Med 2010;170 (12) 1024- 1031PubMedGoogle Scholar 2. Brugts JJYetgin THoeks SE et al. The benefits of statins in people without established cardiovascular disease but with cardiovascular risk factors: meta-analysis of randomised controlled trials. BMJ 2009;338b2376PubMed10.1136/bmj.b2376Google Scholar 3. Mills EJRachlis BWu PDevereaux PJArora PPerri D Primary prevention of cardiovascular mortality and events with statin treatments: a network meta-analysis involving more than 65,000 patients. J Am Coll Cardiol 2008;52 (22) 1769- 1781PubMedGoogle Scholar 4. Thavendiranathan PBagai ABrookhart MAChoudhry NK Primary prevention of cardiovascular diseases with statin therapy: a meta-analysis of randomized controlled trials. Arch Intern Med 2006;166 (21) 2307- 2313PubMedGoogle Scholar 5. Ridker PMDanielson EFonseca FA et al. JUPITER Study Group, Rosuvastatin to prevent vascular events in men and women with elevated C-reactive protein. N Engl J Med 2008;359 (21) 2195- 2207PubMedGoogle Scholar

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Dec 13, 2010

Keywords: primary prevention,statins,cardiovascular disease risk factors

References