@article{03157f2399ef4fd2a07cc6976c70c5de,
title = "Clinical and public health assessment of benefits and risks of statins in primary prevention of coronary events: Resolved and unresolved issues",
abstract = "Peer-reviewed, evidence-based recommendations for statin use in primary prevention of cardiovascular events are limited. A narrative review of published randomized controlled trials and meta-analyses was conducted to critically appraise the benefits and risks of statins in primary prevention. Statins effectively reduce plasma concentrations of low-density lipoprotein cholesterol, and reduce the risk of cardiovascular events and death. The greatest benefits are observed in high-risk subjects, such as patients with diabetes or hypertension. Serious cardiovascular events should not be included among serious adverse events because they are efficacy outcomes and are dependent on the baseline risk of patients. Rates of specific serious adverse events, such as cancer and rhabdomyolysis, seem to be similar between the statin and control arms of the clinical trials examined. Thus, the benefits of statins in primary prevention outweigh the risks, particularly among high-risk patients. However, the benefit-risk ratio would likely be optimized through interventions designed to increase persistence and adherence in a real-life setting.",
keywords = "Clinical trials, Coronary artery disease, Drugs, Health outcomes, Hypercholesterolemia, Prevention",
author = "Yola Moride and Hegele, {Robert A.} and Anatoly Langer and Ruth McPherson and Miller, {David B.} and St{\'e}phane Rinfret",
note = "Funding Information: – indicates less with statin; + indicates more with statin; AFCAPS/TexCAPS Air Force/Texas Coronary Atherosclerosis Prevention Study; ALLHAT-LLT Antihypertensive and Lipid-lowering Treatment to Prevent Heart Attack Trial – Lipid-Lowering Therapy; ASCOT-LLA Anglo-Scandinavian Cardiac Outcomes Trial – Lipid-Lowering Arm; CARDS Collaborative Atorvastatin Diabetes Study; CVD Cardiovascular disease; MRC/HBF HPS Medical Research Council/British Heart Foundation Heart Protection Study; NR Not reported; PROSPER PROspective Study of Pravastatin in the Elderly at Risk; WOSCOPS West Of Scotland Coronary Prevention Study. *P<0.05 Funding Information: *If not clearly stated in the original publication, the percentage of participants in primary prevention was taken from the Cholesterol Treatment Trialists{\textquoteright} Collaborators meta-analysis (13); †Mean change from baseline in control group minus mean change from baseline in statin group; ‡For primary prevention subgroup only. AFCAPS/TexCAPS Air Force/Texas Coronary Atherosclerosis Prevention Study; ALLHAT-LLT Antihypertensive and Lipid-lowering Treatment to Prevent Heart Attack Trial – Lipid-Lowering Therapy; ASCOT-LLA Anglo-Scandinavian Cardiac Outcomes Trial – Lipid-Lowering Arm; CARDS Collaborative Atorvastatin Diabetes Study; MRC/BHF HPS Medical Research Council/British Heart Foundation Heart Protection Study; PROSPER PROspective Study of Pravastatin in the Elderly at Risk; WOSCOPS West Of Scotland Coronary Prevention Study; CAD Coronary artery disease; CRV Coronary revascularization; CVD Cardiovascular disease; HDL High-density lipoprotein cholesterol; HT Hypertension; LDL Low-density lipoprotein cholesterol; MI Myocardial infarction; NNT Number needed to treat; NR Not reported; NS Not significant; RCT Randomized controlled trial; TC Total cholesterol; TG Total triglycerides; TIA Transient ischemic attack; TRV Total revascularization procedures (coronary and noncoronary); yrs Years",
year = "2008",
month = apr,
doi = "10.1016/S0828-282X(08)70179-X",
language = "English (US)",
volume = "24",
pages = "293--300",
journal = "Canadian Journal of Cardiology",
issn = "0828-282X",
publisher = "Pulsus Group Inc.",
number = "4",
}