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 .
HDL cholesterol and residual risk of first cardiovascular events after treatment with potent statin therapy: an analysis from the JUPITER trial
BACKGROUND HDL-cholesterol concentrations are inversely associated with occurrence of  cardiovascular events . We addressed , using the JUPITER trial cohort , whether this association remains when LDL-cholesterol concentrations are reduced to the very low ranges with high-dose statin treatment . METHODS Participants in the r and omised placebo-controlled JUPITER trial were adults without diabetes or previous cardiovascular disease , and had baseline concentrations of LDL cholesterol of less than 3.37 mmol/L and high-sensitivity C-reactive protein of 2 mg/L or more . Participants were r and omly allocated by a computer-generated sequence  to receive rosuvastatin 20 mg per day or placebo , with participants and adjudicators masked to treatment assignment . In the present analysis , we divided the participants into quartiles of HDL-cholesterol or apolipoprotein A1 and sought evidence of association between these quartiles and the JUPITER primary endpoint of first non-fatal myocardial infa rct ion or stroke , hospitalisation for unstable angina , arterial revascularisation , or cardiovascular death . This trial is registered with Clinical Trials.gov , number NCT00239681 . FINDINGS For 17,802 patients in the JUPITER trial , rosuvastatin 20 mg per day reduced the incidence of the primary endpoint by 44 % ( p<0.0001 ) . In 8901 ( 50 % ) patients given placebo ( who had a median on-treatment LDL-cholesterol concentration of 2.80 mmol/L [ IQR 2.43 - 3.24 ] ) , HDL-cholesterol concentrations were inversely related to vascular risk both at baseline ( top quartile vs bottom quartile hazard ratio [ HR ] 0.54 , 95 % CI 0.35 - 0.83 , p=0.0039 ) and on-treatment ( 0.55 , 0.35 - 0.87 , p=0.0047 ) . By contrast , among the 8900 ( 50 % ) patients given rosuvastatin 20 mg ( who had a median on-treatment LDL-cholesterol concentration of 1.42 mmol/L [ IQR 1.14 - 1.86 ] ) , no significant relationships were noted between quartiles of HDL-cholesterol concentration and vascular risk either at baseline ( 1.12 , 0.62 - 2.03 , p=0.82 ) or on-treatment ( 1.03 , 0.57 - 1.87 , p=0.97 ) . Our analyses for apolipoprotein A1 showed an equivalent strong relation to frequency of primary outcomes in the placebo group but little association in the rosuvastatin group . INTERPRETATION Although measurement of HDL-cholesterol concentration is useful as part of initial cardiovascular risk assessment , HDL-cholesterol concentrations are not predictive of residual vascular risk among patients treated with potent statin therapy who attain very low concentrations of LDL cholesterol . FUNDING AstraZeneca
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 .