Statins for the Primary Prevention of Coronary Heart Disease.

Min Li,Xinyi Li,Xiaoli Wang,Yaodong Miao,Hongcai Shang,Xiaoyi Tang,Heqing Chen,Yeyin Hu,Guihua Tian,Xiatian Zhang

doi:10.1155/2019/4870350

Abstract

Object The purpose of this study was to fully assess the role of statins in the primary prevention of coronary heart disease (CHD). Methods We searched six databases (PubMed, the Cochrane Library, Web of Science, China National Knowledge Infrastructure, Wanfang Database, and Chinese Scientific Journal Database) to identify relevant randomized controlled trials (RCTs) from inception to 31 October 2017. Two review authors independently assessed the methodological quality and analysed the data using Rev Man 5.3 software. Risk ratios and 95% confidence intervals (95% CI) were pooled using fixed/random-effects models. Funnel plots and Begg's test were conducted to assess publication bias. The quality of the evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Results Sixteen RCTs with 69159 participants were included in this review. Statins can effectively decrease the occurrence of angina (RR=0.70, 95% CI: 0.58~0.85, I2 =0%), nonfatal myocardial infarction (MI) (RR=0.60, 95% CI: 0.51~0.69, I2 =14%), fatal MI (RR=0.49, 95% CI: 0.24~0.98, I2 =0%), any MI (RR=0.53, 95% CI: 0.42~0.67, I2 =0%), any coronary heart events (RR=0.73, 95% CI: 0.68~0.78, I2=0%), coronary revascularization (RR=0.66, 95% CI: 0.55~0.78, I2 = 0%), and any cardiovascular events (RR=0.77, 95% CI: 0.72~82, I2 = 0%). However, based on the current evidence, there were no significant differences in CHD deaths (RR=0.82, 95% CI: 0.66~1.02, I2=0%) and all-cause mortality (RR=0.88, 95% CI: 0.76 ~1.01, I2 =58%) between the two groups. Additionally, statins were more likely to result in diabetes (RR=1.21, 95% CI: 1.05~1.39, I2 =0%). There was no evidence of publication biases, and the quality of the evidence was considered moderate. Conclusion Statins seemed to be beneficial for the primary prevention of CHDs but have no effect on CHD death and all-cause mortality.

Highlights

Cardiovascular diseases (CVDs) are the primary public health problem and a chief cause of morbidity and mortality worldwide
Statins can effectively decrease the occurrence of angina (RR=0.70, 95% confidence intervals (95% CI): 0.58∼0.85, I2 =0%), nonfatal myocardial infarction (MI) (RR=0.60, 95% CI: 0.51∼0.69, I2 =14%), fatal MI (RR=0.49, 95% CI: 0.24∼0.98, I2 =0%), any MI (RR=0.53, 95% CI: 0.42∼0.67, I2 =0%), any coronary heart events (RR=0.73, 95% CI: 0.68∼0.78, I2=0%), coronary revascularization (RR=0.66, 95% CI: 0.55∼0.78, I2 = 0%), and any cardiovascular events (RR=0.77, 95% CI: 0.72∼82, I2 = 0%)
In these meta-analyses from 16 studies with 69159 participants without a history of coronary heart disease (CHD), we found that statins can effectively decrease the occurrence of angina, nonfatal and/or fatal MI, any coronary heart events, coronary revascularization and any cardiovascular events

Summary

Introduction

Cardiovascular diseases (CVDs) are the primary public health problem and a chief cause of morbidity and mortality worldwide. 17.9 million people die from CVDs every year, accounting for 31% of all deaths globally [1]. AS causes cardiovascular stenosis and/or obstruction, further leading to myocardial ischaemia and hypoxia and giving rise to myocardial necrosis and even cardiac death. CHD is divided into chronic coronary artery disease (stable angina) and acute coronary syndrome (including unstable angina, non-ST-segment elevation myocardial infarction [NSTEMI], ST-segment elevation myocardial infarction [STEMI], and sudden coronary death). CHD causes nearly one-third of all deaths globally [3] and is responsible for 15.5 million persons ≥20 years of age having CHD in the United States [4]. In China, the prevalence of CHD surpassed 80 million in 2010, causing death in over one million people every year [5]

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