Meta-analysis of the cardiovascular benefits of intensive lipid lowering with statins

Objective - To evaluate the efficacy of intensive lipid lowering with higher-dose statins. Methods - Meta-analysis of seven randomized controlled trials comprising 50,972 participants. Results - Mean follow-up was 3.1 years with mean age 63 years. Final LDL-C levels in intensive lipid-lowering group were 1.42-2.07 mmol/l compared to 2.1-3.5 mmol/l in the less intensive or control group. The intensive arm had significantly lower risks for stroke OR 0.80 (95% CI 0.71-0.89); major coronary events OR 0.74 (95% CI 0.65-0.83); cardiovascular disease (CVD) or coronary heart disease (CHD) deaths OR 0.84 (95% CI 0.74-0.95). Significantly higher liver enzyme abnormalities occurred in intensive group* (OR 3.96; 95% CI 2.08 7.53), but it was not associated with drug discontinuations (OR 1.20; 95% CI 0.88-1.64). Conclusion - In those at high risk of cardiovascular events, intensive lipid lowering with statins to LDL-C level <2.1 mmol/l significantly reduces risk of stroke, major coronary events and CVD or CHD deaths compared to LDL-C level >= 2.1 mmol/l. [*Correction added on 11 January 2011 after first online publication on 27 October 2010. The phrase, :Significantly higher liver enzyme abnormalities occurred in less intensive group'', was amended to Significantly higher liver enzyme abnormalities occurred in intensive group''.]