Effect of statins and non-statin LDL-lowering medications on cardiovascular outcomes in secondary prevention: a meta-analysis of randomized trials
Pooled resultResult — go to the resultRelative risk 0.81 95% CI 0.77–0.86Authors' conclusion
Reduction of MVE is proportional to the magnitude of LDL-C lowering across a broad spectrum of on-treatment levels in secondary prevention. Statin intensification and add-on treatment with PCSK9 inhibitors or ezetimibe are associated with significant reduction of cardiovascular morbidity in this very high-risk population.
Study context
- Population
- Secondary prevention; RCTs with >500 patients followed ≥1 year
- Participants
- 152,507 participants · 19 trials
- Comparison
- More-intensive vs less-intensive LDL-C lowering
- More-intensiven = 76,678
- Less-intensiven = 75,829reference
- Outcome
- Major vascular events (MVEs)
Methodological detailsrandom-effects models
- Random-effects models
Pooled result
As reported in the abstract
Relative risk
0.81
95% CI 0.77–0.86
More-intensive vs Less-intensive
RR 0.81 (95% CI 0.77–0.86)
Further pooled results
| Outcome | RR (95% CI) | |
|---|---|---|
| MVEs, by type of more-intensive treatment (subgroup)More-intensive vs Less-intensive · statins | 0.81 (0.76–0.86) | |
| MVEs, by type of more-intensive treatment (subgroup)More-intensive vs Less-intensive · non-statin agents (PCSK9 inhibitors and ezetimibe) | 0.85 (0.77–0.94) | |
| 0.512Relative risk (log scale) |
- Major vascular events (MVEs), by type of more-intensive treatment (subgroup): interaction P = 0.38
MVE per 1.0 mmol/L LDL-C reduction
- Relative decrease in MVE per 1.0 mmol/L LDL-C reduction
- 19%
MVEs by baseline and achieved LDL-C reduction
- Risk reduction greater across higher baseline levels and greater achieved reductions of LDL-C
Death, CV death, MI, stroke, coronary revascularization
- All favoured more-intensive treatment
Original publication
Effect of statins and non-statin LDL-lowering medications on cardiovascular outcomes in secondary prevention: a meta-analysis of randomized trials. Eur Heart J. Published 23 October 2017. doi:10.
Summarised from the published abstract; every number is checked against it