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Statins Provide Less Benefit in Populations with High Noncardiovascular Mortality Risk: Meta‐Regression of Randomized Controlled Trials
Author(s) -
Kim Caroline A.,
Kim Dae Hyun
Publication year - 2015
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/jgs.13476
Subject(s) - medicine , relative risk , confidence interval , population , placebo , meta regression , myocardial infarction , meta analysis , stroke (engine) , environmental health , mechanical engineering , alternative medicine , pathology , engineering
Objectives To examine whether the benefit of statins varied according to cardiovascular ( CV ) and non‐ CV mortality of the treated population. Design Meta‐analysis and meta‐regression of 16 randomized placebo‐controlled trials. Setting Community and hospital. Participants Statin‐ (n = 59,671) and placebo‐treated (n = 59,707) individuals with and without CV disease (mean age 55 to 75). Measurements Meta‐regression was used to model relative risks ( RR s) of major CV events (myocardial infarction and stroke) and total mortality for statins versus placebo as a function of CV and non‐ CV mortality risks of the study population. Results Every 1% increase in 5‐year non‐ CV mortality risk of the study population was associated with a 3.7% (95% confidence interval ( CI ) = 1.2 to 6.3%) greater RR of major CV events and a 4.4% (95% CI = 2.1 to 6.9%) greater RR of total mortality. (Higher RR s indicate smaller benefits.) CV mortality was not associated with statin effects ( P > .05). In stratified analysis according to CV (≥5.3% vs <5.3%) and non‐ CV mortality (≥3.8% vs <3.8%) of the study population, statins had little mortality benefit in populations with high non‐ CV mortality, regardless of CV mortality (random‐effects pooled RR = 0.81, 95% CI = 0.72 to 0.91, for low CV and low non‐ CV mortality; random‐effects pooled RR = 0.90, 95% CI = 0.76 to 1.06 for low CV and high non‐ CV mortality; random‐effects pooled RR = 0.79, 95% CI = 0.72 to 0.87 for high CV and low non‐ CV mortality; random‐effects pooled RR = 0.94, 95% CI = 0.87 to 1.02 for high CV and high non‐ CV mortality). The CV event reduction was also attenuated in populations with high non‐ CV mortality (random‐effects pooled RR = 0.67, 95% CI = 0.60 to 0.75, for low CV and low non‐ CV mortality; random‐effects pooled RR = 0.73, 95% CI = 0.66 to 0.81 for low CV and high non‐ CV mortality; random‐effects pooled RR = 0.77, 95% CI = 0.69 to 0.87 for high CV and low non‐ CV mortality; random‐effects pooled RR = 0.83, 95% CI = 0.74 to 0.92 for high CV and high non‐ CV mortality). Conclusion Benefits of statins may depend on the non‐ CV mortality risk of the treated population. This should be confirmed using individual‐level data.