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 .
Reduction in C-reactive protein and LDL cholesterol and cardiovascular event rates after initiation of rosuvastatin: a prospective study of the JUPITER trial
BACKGROUND Statins lower high-sensitivity C-reactive protein ( hsCRP ) and cholesterol concentrations , and hypothesis generating analyses suggest that clinical outcomes improve in patients given statins who achieve hsCRP concentrations less than 2 mg/L in addition to LDL cholesterol less than 1.8 mmol/L ( < 70 mg/dL ) . However , the benefit of lowering both LDL cholesterol and hsCRP after the start of statin therapy is controversial . We prospect ively tested this hypothesis . METHODS In an analysis of 15 548 initially healthy men and women participating in the JUPITER trial ( 87 % of full cohort ) , we prospect ively assessed the effects of rosuvastatin 20 mg versus placebo on rates of non-fatal myocardial infa rct ion , non-fatal stroke , admission for unstable angina , arterial revascularisation , or cardiovascular death ( prespecified endpoints ) during a maximum follow-up of 5 years ( median 1.9 years ) , according to on-treatment concentrations of LDL cholesterol ( > /=1.8 mmol/L or < 1.8 mmol/L ) and hsCRP ( > /=2 mg/L or < 2 mg/L ) . We included all events occurring after r and omisation . This trial is registered with Clinical Trials.gov , number NCT00239681 . FINDINGS Compared with placebo , participants allocated to rosuvastatin who achieved LDL cholesterol less than 1.8 mmol/L had a 55 % reduction in vascular events ( event rate 1.11 vs 0.51 per 100 person-years ; hazard ratio [ HR ] 0.45 , 95 % CI 0.34 - 0.60 , p<0.0001 ) , and those achieving hsCRP less than 2 mg/L a 62 % reduction ( event rate 0.42 per 100 person-years ; HR 0.38 , 95 % CI 0.26 - 0.56 , p<0.0001 ) . Although LDL cholesterol and hsCRP reductions were only weakly correlated in individual patients ( r values < 0.15 ) , we recorded a 65 % reduction in vascular events in participants allocated to rosuvastatin who achieved both LDL cholesterol less than 1.8 mmol/L and hsCRP less than 2 mg/L ( event rate 0.38 per 100 person-years ; adjusted HR 0.35 , 95 % CI 0.23 - 0.54 ) , versus a 33 % reduction in those who achieved one or neither target ( event rate 0.74 per 100 person-years ; HR 0.67 , 95 % CI 0.52 - 0.87 ) ( p across treatment groups < 0.0001 ) . In participants who achieved LDL cholesterol less than 1.8 mmol/L and hsCRP less than 1 mg/L , we noted a 79 % reduction ( event rate 0.24 per 100 person-years ; HR 0.21 , 95 % CI 0.09 - 0.52 ) . Achieved hsCRP concentrations were predictive of event rates irrespective of the lipid endpoint used , including the apolipoprotein B to apolipoprotein AI ratio . INTERPRETATION For people choosing to start pharmacological prophylaxis , reduction in both LDL cholesterol and hsCRP are indicators of successful treatment with rosuvastatin
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 .