Efficacy of standard and intensive statin treatment for the secondary prevention of cardiovascular and cerebrovascular events in diabetes patients: a meta-analysis.

Folgerdiena M De Vries,Johan Kolthof,Maarten J Postma,Eelko Hak,Petra Denig

doi:10.1371/journal.pone.0111247

Folgerdiena M De Vries, Johan Kolthof + Show 3 more

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https://doi.org/10.1371/journal.pone.0111247

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Abstract

AimsTo estimate the efficacy of standard and intensive statin treatment in the secondary prevention of major cardiovascular and cerebrovascular events in diabetes patients.MethodsA systematic search was conducted in Medline over the years 1990 to September 2013. Randomized, double-blind, clinical trials comparing a standard-dose statin with placebo or a standard-dose statin with an intensive-dose statin for the secondary prevention of cardiovascular and cerebrovascular events in diabetes patients were selected. Trial and patient characteristics were extracted independently by two researchers. The combined effect on the composite primary endpoint was measured with a fixed-effect model. Potential publication bias was examined with a funnel plot.ResultsFive trials were included in the analysis comparing standard-dose statins with placebo with a total of 4 351 participants. Four trials were included for comparing standard-dose with intensive-dose statins, including 4 805 participants. Compared with placebo, standard-dose statin treatment resulted in a significant relative risk (RR) reduction of 15% in the occurrence of any major cardiovascular or cerebrovascular event (RR 0.85, 95% CI 0.79–0.91). Compared with standard-dose statin treatment, intensive-dose statin treatment resulted in an additional 9% relative risk reduction (RR 0.91, 95% CI 0.84–0.98).ConclusionTreatment with standard-dose statins to prevent cardiovascular or cerebrovascular events in diabetes patients with manifest cardiovascular disease results in an estimated 15% relative risk reduction and intensive-dose statin treatment adds 9%. If proven cost-effective, more intensive statin treatment should be recommended for diabetes patients at high cardiovascular risk.

Highlights

Cardio- and cerebrovascular diseases are ranked among the major causes of mortality worldwide [1]
If proven cost-effective, more intensive statin treatment should be recommended for diabetes patients at high cardiovascular risk
Description of included randomized clinical trials Data from nine randomized clinical trials were included in the current meta-analyses (Fig. 1): the 4S [25], the ASPEN [7], the CARE [26], the HPS [27] and the LIPID [28] trial for the comparison of a standard-dose statin with placebo and the A to Z [13], the PROVE-IT TIMI [14], the SEARCH [15] and the TNT [16] trials for the comparison of standard-dose statin treatment with intensive-dose statin treatment

Summary

Introduction

Cardio- and cerebrovascular diseases are ranked among the major causes of mortality worldwide [1]. Significant benefits of statin treatment were reported in two meta-analyses, leading to the conclusion that statin therapy reduces the occurrence of major vascular events in diabetes patients with and without vascular disease [5,6]. These analyses did not include the ASPEN study, which did not show significant results with a standard-dose statin in diabetes patients [7]. For clinical decision making and cost-effectiveness analysis it is important to have precise effect estimates of standard and intensive statin treatment for secondary prevention diabetes patients

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