Authors' objectives:

This study is a review of published clinical trials and pharmacoeconomic evaluations of lipid-lowering agents, focussing mainly on HMG-CoA reductase inhibitors. The report discusses the relationship between lipids and coronary events. It then examines the impact of lipid-lowering therapy on coronary events.

Authors' results and conclusions: Based on findings from epidemiological studies, an elevated total cholesterol level increases the risk of experiencing a coronary event. Low HDL and high LDL levels as well as an elevated TC/HDL ratio are also predictors for coronary heart disease. Coronary heart disease is a multifactorial disorder and, in addition to the dyslipidemia, other risk factors for CHD must be taken into account when determining treatment goals. Before HMG-CoA reductase inhibitors became available, lipid-lowering therapy significantly reduced coronary events (fatal and non-fatal CHD combined) in high risk populations in primary prevention. However, fatal CHD alone and overall mortality had not been shown to be significantly reduced. In secondary prevention, coronary events were significantly reduced and overall mortality was also reduced, although not significantly, by lipid-lowering therapy. Greater absolute benefits are more likely to be realized in patients at high risk of experiencing a coronary event. Even though secondary prevention trials demonstrated a larger impact on the incidence of CHD, results have been consistent, showing a decrease in coronary events in both primary and secondary prevention trials. There is no conclusive evidence that a low cholesterol level increases the risk of depression, cancer or trauma.

Authors' recommendations: Due to the lack of long-term clinical trials with the other statins and the lack of head to head trials in general, it has not been conclusively determined if some statins produce greater clinical benefits than others. Follow-ups in clinical trials have been limited to five years or less. Patients may take these drugs for longer than this period. Long-term safety remains to be established. If a statin is required, consideration should be given to choosing a statin based on its ability to lower LDL levels and raise HDL, the patient's concurrent medical conditions and concomitant drug therapy, and cost. Clinicians must also keep in mind the information available for each statin as well as the generalizability of the evidence from clinical trials to the patient.

Authors' methods: Review

Project Status: Completed

URL for project: https://www.ccohta.ca/pubs/english/statins/

Year Published: 1997

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Canada

Organisation Name: Canadian Coordinating Office for Health Technology Assessment

Contact Address: 600-865 Carling Avenue, Ottawa, ON K1S 5S8 Canada. Tel: +1 613 226 2553, Fax: +1 613 226 5392;

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Copyright: Canadian Coordinating Office for Health Technology Assessment