Statins - primary prevention

The information below is from Therapeutic initiatives Canada

The Scientific Information and Education Committee, the main working body of the Therapeutics Initiative, is made up of family physicians, specialists, academic researchers, clinical pharmacologists, pharmacists, epidemiologists, and a legal advisor. The mandate of this Committee is to be responsible for the accuracy and quality of the drug assessment process and to assist in the translation of the evidence into clinically relevant messages.

Primary prevention is the use of statins for those who have not had a cardiovascular event in order to prevent one.

Conclusions:

• If cardiovascular serious adverse events are viewed in isolation, 71 primary prevention patients with cardiovascular risk factors have to be treated with a statin for 3 to 5 years to prevent one myocardial infarction or stroke.

• This cardiovascular benefit is not reflected in 2 measures of overall health impact, total mortality and total serious adverse events. Therefore, statins have not been shown to provide an overall health benefit in primary prevention trials.

• A question to us about Letter #48: What is the evidence of benefit for primary prevention in women?

  There were 10,990 women in the primary prevention trials (28% of the total). Only coronary events were reported for women, but when these were pooled they were not reduced by statin therapy, RR 0.98 [0.85-1.12]. Thus the coronary benefit in primary prevention trials appears to be limited to men, RR 0.74 [0.68-0.81], ARR 2.0%, NNT 50 for 3 to 5 years.