Authors' objectives:

This report presents the principal findings of a systematic review and critical appraisal of randomized controlled trials examining the impact of lipid lowering drugs on coronary heart disease morbidity and mortality.

Authors' recommendations: In secondary prevention, in men age 35 to 70, the benefits from using statins are clear. Treatment with niacin is also effective but is associated with statistically significant increases in potentially serious side effects. In primary prevention, the West of Scotland trial found that in men age 45 to 64 taken from a population with an ischaemic heart disease (IHD) mortality rate three to four times that of Canadian men, pravastatin produced statistically significant reduction in non-fatal myocardial infarction (MI). In other words, in this trial, the 5-year probability of not having an MI increased in average from 93.5% to 95.4% with pravastatin. Because of the lower IHD mortality rate in Canada, smaller attributable risk reductions and larger numbers needed to treat are expected. In secondary prevention, in women post-menopause to age 70, one subgroup analysis found a statistically significant reduction in non-fatal MI with simvastatin. However, the treatment and control groups differed at baseline, and this may explain some of the difference in non-fatal MI. In one trial, pravastatin was associated with an unexpected, statistically significant increase in breast cancer in women. In primary prevention, in women, no trial has demonstrated that lipid lowering drugs reduce CHD morbidity or mortality. In secondary prevention, in men and women over age 70, one trial found a statistically significant effect only when combining CHD and procedural endpoints. Procedural endpoints were found to be inappropriate surrogates for clinical endpoints. At this time, it is not possible to make conclusions on the effectiveness of lipid lowering drugs on CHD morbidity or mortality in this group. In primary prevention, in men and women over age 70, no trial has demonstrated that lipid lowering drugs reduce CHD morbidity or mortality.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://www.chspr.ubc.ca/bcohta/

Year Published: 1998

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Canada

Organisation Name: British Columbia Office of Health Technology Assessment

Contact Address: B. C. Office of Health Technology Assessment, Centre for Health Services and Policy Research, S-184 Koerner Pavilion, 2211 Wesbrook Mall, The University of British Columbia, Vancouver, B. C., V6T 1Z3, Canada.

Copyright: BCOHTA