Postponement of cardiovascular outcomes by statin use: A systematic review and meta-analysis of randomized clinical trials

Morten Rix Hansen, Asbjørn Hróbjartsson, Anton Pottegård, Per Damkier, Kenneth Grønkjaer Madsen, Manan Pareek, Morten Olesen, Jesper Hallas, Morten Rix Hansen, Asbjørn Hróbjartsson, Anton Pottegård, Per Damkier, Kenneth Grønkjaer Madsen, Manan Pareek, Morten Olesen, Jesper Hallas

Abstract

Objective: To estimate the average outcome postponement (gain in days to an event) for cardiovascular outcomes in a meta-analysis of randomized, controlled statin trials, including any myocardial infarction, any stroke and cardiovascular death.

Design: Systematic review of large randomized, placebo-controlled trials of statin use, including a random-effects meta-analysis of all included trials.

Data sources: We searched MEDLINE (15 July 2019) and ClinicalTrials.gov (16 October 2019).

Eligibility criteria for selecting studies: Randomized, placebo-controlled trials of statin use that included at least 1000 participants. We identified 15 cardiovascular outcomes that were reported in more than 2 trials.

Results: We included 19 trials. The summary outcome postponements for the 15 cardiovascular outcomes varied between -1 and 38 days. For four major outcomes, the summary outcome postponement in days was as follows: cardiovascular mortality, 9.27 days (95% CI: 3.6 to 14.91; I2 = 72%; 9 trials) non-vascular and non-cardiovascular mortality, 1.5 days (95% CI: -2.2 to 5.3; I2 = 0%; 6 trials) any myocardial infarction 18.0 days (95% CI; 12.1 to 24.1; I2 = 92%; 15 trials); and any stroke, 6.1 days (95% CI; 2.86 to 9.39; I2 = 66%; 14 trials).

Conclusion: Statin treatment provided a small, average postponement of cardiovascular outcomes during trial duration.

Keywords: cardiovascular endpoints; cholesterol; effect measures; meta-analysis; outcome postponement; statins.

© 2020 Nordic Association for the Publication of BCPT (former Nordic Pharmacological Society).

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