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Evidence Summary

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Statins reduce heart attacks and strokes in people 40 to 75 years of age who are at risk of heart disease

Chou R, Dana T, Blazina I, et al. Statins for Prevention of Cardiovascular Disease in Adults: Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA. 2016;316:2008-24.

Review question

In adults 40 years of age or older who have no history of heart (cardiovascular) disease, what are the benefits and harms of statin drugs?

Background

Heart disease includes diseases of the heart or its blood vessels, such as coronary heart disease (ischemic heart disease). Some heart disease is caused by an excess of some types of fat (cholesterol) in the blood.

People who have heart disease are often prescribed statins. These drugs lower cholesterol levels in the blood and reduce the risk of future heart disease–related events such as heart attacks or strokes. Statins may also prevent these events in people who do not have heart disease but are at risk of getting it.

How the review was done

The researchers did a systematic review, searching for English-language studies up to June 2016.

They found 19 randomized controlled trials with 71,344 people (average age 51 to 66 years).

The key features of the trials were:

  • people were at risk of getting heart disease, and a few (less than 10%) already had it;
  • treatment was a statin, including atorvastatin, cerivastatin, fluvastatin, lovastatin, pravastatin, rosuvastatin, or simvastatin;
  • statins were compared with a placebo or no statin treatment; and
  • people were followed for 6 months to 6 years.

What the researchers found

Compared with placebo or no statin treatment:

  • statins reduced heart attacks, strokes, any heart disease–related events, and death due to heart disease or any cause; and
  • statins did not increase risk for serious adverse events (such as cancer, muscle pain, muscle breakdown or increased liver enzymes).

Conclusion

In people 40 to 75 years of age who don’t have heart disease, but are at risk of getting it, statins reduce heart attacks, strokes, heart disease–related events, and death due to heart disease or any cause.

Based on the findings of this review and other considerations, the U.S. Preventive Services Task Force made recommendations about the use of statins in people who don’t have heart disease but are at risk of getting it. You can find these recommendations in the following document: U.S. Preventive Services Task Force, Bibbins-Domingo K, Grossman DC, et al. Statin use for the primary prevention of cardiovascular disease in adults: U.S. Preventive Services Task Force recommendation statement. JAMA. 2016;316:1997-2007. 27838723 or at U.S. Preventive Services Task Force.

A personal risk calculator recommended by the U.S. Preventive Services Task Force is available at www.cvriskcalculator.com.

Statins vs control (placebo or no statins) in adults 40 to 75 years of age without heart disease but at increased risk of getting heart disease*

Outcomes

Number of trials and people

Rate of events with statins

Rate of events with control

Absolute effect of statins over 6 months to 6 years

Death from any cause

15 trials (71,131 people)

3.1%

3.6%

About 4 fewer people out of 1,000 died (from as few as 2 to as many as 7)

Death due to heart disease

10 trials (64,235 people)

1.2%

1.7%

About 5 fewer people out of 1,000 died due to heart disease (from as few as 2 to as many as 8)

Heart attack

12 trials (68,537 people)

1.4%

2.2%

About 9 fewer people out of 1,000 had a heart attack (from as few as 5 to as many as 12)

Stroke

13 trials (62,863 people)

1.1%

1.5%

About 4 fewer people out of 1,000 had a stroke (from as few as 3 to as many as 6)

Any heart disease–related event

13 trials (69,215 people)

3.2%

4.6%

About 14 fewer people out of 1,000 had a heart disease–related event (from as few as 10 to as many as 18)

Serious adverse event†

7 trials (41,804 people)

12.9%

13.0%

No difference in effect‡

*Some trials included people younger than 40 years of age or older than 75 years of age; however, the average age of people across all trials was 51 to 66 years. Some trials included a few people (< 10%) who already had heart disease.

†Including cancer, muscle pain, muscle breakdown, and increased liver enzymes.

‡Although the rates for the 2 groups look a little different, the differences were not statistically significant. This means that the differences could simply be due to chance rather than due to the different treatments.




Glossary

Coronary heart disease
Also known as coronary artery disease (CAD), is a narrowing of the blood vessels (coronary arteries) that supply oxygen and blood to the heart.
Placebo
A harmless, inactive, and simulated treatment.
Randomized controlled trials
Studies where people are assigned to one of the treatments purely by chance.
Systematic review
A comprehensive evaluation of the available research evidence on a particular topic.
Vascular
The body's network of blood vessels. It includes the arteries, veins, and capillaries that carry blood to and from the heart.

Related Web Resources

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    Compression stockings help to prevent deep vein thrombosis (blood clots and swelling) after surgery. You can choose to wear thigh or knee length stockings.
  • Coronary artery disease risk screening

    Health Link B.C.
    Men over 40 and women past menopause or over 50 should get screened for coronary artery disease (CAD) every 1 to 3 years. Your risk is higher if you have diabetes, high blood pressure, abdominal obesity, kidney disease, family history of CAD or if you smoke.
  • High cholesterol: Does reducing the amount of fat in your diet help?

    Informed Health Online
    Eat less saturated fats in your diet to help prevent heart disease. Eat less meat, butter, cheese and cream to improve your health long-term.
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