AIMS: Statin therapy is associated with important benefits for @entity1 at risk of, and with, established @entity65 . There is widespread interest in whether intensive dosing of statins yields larger treatment effects. We aimed to determine if intensive dosing is clinically important using a meta-analysis of randomized clinical trials (RCTs). METHODS: We conducted comprehensive searches of electronic databases from inception to December 2010. We included any RCT evaluating a larger dose with a clinically common dose. Two reviewers independently extracted data, in duplicate. We performed random-effects meta-analysis and a trial sequential analysis. RESULTS: We identified 10 RCTs enrolling a total of 41 778 @entity1 . Trials followed @entity1 for a mean of 2.5 years. We did not find statistically significant effects on all-cause mortality [relative risk (RR) 0.92, 95% confidence interval (CI), 0.83-1.03, P = 0.14, I(2) = 38%] or @entity65 ( @entity65 ) deaths (RR 0.89, 95% CI, 0.78-1.01, P = 0.07, I(2) = 34%). When we pooled the composite endpoint of @entity301 ( @entity301 ) death plus non-fatal @entity583 ( @entity583 ), we found a significant protective effect of intensive statin dosing (RR 0.90, 95% CI, 0.84-0.96, P  <= 0.0001, I(2) = 0%). We also found a significant effect on non-fatal MIs (RR 0.82, 95% CI, 0.76-0.89, P  <= 0.0001, I(2) = 0%) and a significant @entity64 (excluding transient @entity2142 ) reported in 10 RCTs (RR 0.86, 95% CI, 0.77-0.96, P = 0.006, I(2) = 0%). A subgroup analysis of three trials examining @entity1187 @entity1 found significant effects on all-cause (RR 0.75, 95% CI, 0.61-0.91, P = 0.005, I(2) = 0%) and @entity65 mortality (RR 0.74, 95% CI, 0.59-0.94, P = 0.013, I(2) = 0%) with intensive dosing. Applying an analysis of optimal information size on the primary analysis, we found that the evidence for @entity301 death plus non-fatal MIs is conclusive. The evidence for @entity65 deaths alone is not yet conclusive. CONCLUSIONS: Available evidence suggests that intensive statin therapy reduces the risk of non-fatal events and may have a role in reducing mortality.

Intensive statin therapy compared with moderate dosing for prevention of cardiovascular events: a meta-analysis of >40 000 XXXX .

@entity1 :: ('9606', 'Species') :: ['participants', 'patients'] @entity1187 :: ('MESH:D054058', 'Disease') :: ['acute coronary syndrome'] @entity64 :: ('MESH:D020521', 'Disease') :: ['reduction in the composite of fatal and non-fatal strokes'] @entity301 :: ('MESH:D003327', 'Disease') :: ['CHD', 'coronary heart disease'] @entity2142 :: ('MESH:D006461', 'Disease') :: ['ischaemic attacks'] @entity583 :: ('MESH:D009203', 'Disease') :: ['myocardial infarction', 'MI'] @entity65 :: ('MESH:D002318', 'Disease') :: ['CVD', 'cardiovascular disease']
@entity1 :: (9606,Species) :: ['patients']
