Total cholesterol and LDL cholesterol were reduced in all trials but there was evidence of heterogeneity of effects .
There was no evidence of any serious harm caused by statin prescription .
Evidence available to date showed that primary prevention with statins is likely to be cost-effective and may improve patient quality of life .
Recent findings from the Cholesterol Treatment Trialists study using individual patient data meta- analysis indicate that these benefits are similar in people at lower ( < 1 % per year ) risk of a major cardiovascular event .
AUTHORS ' CONCLUSIONS Reductions in all-cause mortality , major vascular events and revascularisations were found with no excess of adverse events among people without evidence of CVD treated with statins
BACKGROUND Reducing high blood cholesterol , a risk factor for cardiovascular disease ( CVD ) events in people with and without a past history of CVD is an important goal of pharmacotherapy .
Statins are the first-choice agents .
Previous review s of the effects of statins have highlighted their benefits in people with CVD .
The case for primary prevention was uncertain when the last version of this review was published ( 2011 ) and in light of new data an up date of this review is required .
OBJECTIVES To assess the effects , both harms and benefits , of statins in people with no history of CVD .
Interactive effects of fitness and statin treatment on mortality risk in veterans with dyslipidaemia: a cohort study
BACKGROUND Statins are commonly prescribed for management of dyslipidaemia and cardiovascular disease . Increased fitness is also associated with low mortality and is recommended as an essential part of promoting health . However , little information exists about the combined effects of fitness and statin treatment on all-cause mortality . We assessed the combined effects of statin treatment and fitness on all-cause mortality risk . METHODS In this prospect i ve cohort study , we included dyslipidaemic veterans from Veterans Affairs Medical Centers in Palo Alto , CA , and Washington DC , USA , who had had an exercise tolerance test between 1986 , and 2011 . We assigned participants to one of four fitness categories based on peak metabolic equivalents ( MET ) achieved during exercise test and eight categories based on fitness status and statin treatment . The primary endpoint was all-cause mortality adjusted for age , body-mass index , ethnic origin , sex , history of cardiovascular disease , cardiovascular drugs , and cardiovascular risk factors . We assessed mortality from Veteran 's Affairs ' records on Dec 31 , 2011 . We compared groups with Cox proportional hazard model . FINDINGS We assessed 10,043 participants ( mean age 58·8 years , SD 10·9 years ) . During a median follow-up of 10·0 years ( IQR 6·0 - 14·2 ) , 2318 patients died , with an average yearly mortality rate of 22 deaths per 1000 person-years . Mortality risk was 18·5 % ( 935/5046 ) in people taking statins versus 27·7 % ( 1386/4997 ) in those not taking statins ( p<0·0001 ) . In patients who took  statins , mortality risk decreased as fitness increased ; for highly fit individuals ( > 9 MET ; n=694 ) , the hazard ratio ( HR ) was 0·30 ( 95 % CI 0·21 - 0·41 ; p<0·0001 ) compared with least fit ( ≤5 METs ) patients ( HR 1 ; n=1060 ) . For those not treated with statins , the HR for least fit participants ( n=1024 ) was 1·35 ( 95 % CI 1·17 - 1·54 ; p<0·0001 ) and progressively decreased to 0·53 ( 95 % CI 0·44 - 0·65 ; p<0·0001 ) for those in the highest fitness category ( n=1498 ) . INTERPRETATION Statin treatment and increased fitness are independently associated with low mortality  among dyslipidaemic individuals . The combination of statin treatment and increased fitness result ed in substantially lower mortality risk than either alone , reinforcing the importance of physical activity for individuals with dyslipidaemia . FUNDING None
Total cholesterol and LDL cholesterol were reduced in all trials but there was evidence of heterogeneity of effects .
There was no evidence of any serious harm caused by statin prescription .
Evidence available to date showed that primary prevention with statins is likely to be cost-effective and may improve patient quality of life .
Recent findings from the Cholesterol Treatment Trialists study using individual patient data meta- analysis indicate that these benefits are similar in people at lower ( < 1 % per year ) risk of a major cardiovascular event .
AUTHORS ' CONCLUSIONS Reductions in all-cause mortality , major vascular events and revascularisations were found with no excess of adverse events among people without evidence of CVD treated with statins
BACKGROUND Reducing high blood cholesterol , a risk factor for cardiovascular disease ( CVD ) events in people with and without a past history of CVD is an important goal of pharmacotherapy .
Statins are the first-choice agents .
Previous review s of the effects of statins have highlighted their benefits in people with CVD .
The case for primary prevention was uncertain when the last version of this review was published ( 2011 ) and in light of new data an up date of this review is required .
OBJECTIVES To assess the effects , both harms and benefits , of statins in people with no history of CVD .