Bucher HC. Griffith LE. Guyatt GH.
Medizinsche Universitats-Poliklinik, Kantonsspital Basel, Basel,
Systematic review on the
risk and benefit of different
Arteriosclerosis, Thrombosis & Vascular Biology. 19(2):187-95, 1999 Feb.
Meta-analyses have investigated the efficacy of
cholesterol-lowering interventions in relation to the
underlying risk of coronary heart disease and
the extent and duration of cholesterol reduction. We
the efficacy of antilipidemic interventions on major
mortality outcomes in relation to drug classes. We searched MEDLINE and
EMBASE from 1966 through October 1996 for randomized, controlled trials of
any cholesterol-lowering interventions reporting mortality data. We included
59 trials involving 85 431 participants in the intervention
and 87 729 participants in the control groups. We pooled
these trials into 7 pharmacological categories of
cholesterol-lowering interventions: statins (13 trials), fibrates (12
trials), resins (8 trials), hormones (8 trials), niacin acid (2 trials), n-3
fatty acids (3 trials), and dietary interventions (16 trials). Of
the cholesterol-lowering interventions, only statins showed
a large and statistically significant reduction in mortality from coronary
heart disease (risk ratio, 0.66; 95% confidence interval
[CI], 0.54 to 0. 79) and from all causes (risk ratio, 0.75;
95% CI, 0.65 to 0.86). For both all-cause and cardiovascular mortality,
the difference between statins and the
combined estimate of the other classes of
agents was unlikely to be due to chance (P<0.02 for both comparisons).
Meta-regression analysis demonstrated that variability in results across
trials could be largely explained on the basis of
differences in the magnitude of cholesterol reduction.
Statins have the largest effect on the
reduction of cardiovascular and all-cause mortality, and this result
recommends their use in preference to other
antilipidemic agents. The greater effect of statins is
likely due to the larger reduction in cholesterol.
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