Postponement of cardiovascular outcomes by statin use: A systematic review and meta-analysis of randomized clinical trials

Abstract

Objective: To estimate the average outcome postponement (gain in days to an event) for cardiovascular outcomes in a meta-analysis of randomized, controlled statin trials, including any myocardial infarction, any stroke and cardiovascular death.

Design: Systematic review of large randomized, placebo-controlled trials of statin use, including a random-effects meta-analysis of all included trials.

Data sources: We searched MEDLINE (15 July 2019) and ClinicalTrials.gov (16 October 2019).

Eligibility criteria for selecting studies: Randomized, placebo-controlled trials of statin use that included at least 1000 participants. We identified 15 cardiovascular outcomes that were reported in more than 2 trials.

Results: We included 19 trials. The summary outcome postponements for the 15 cardiovascular outcomes varied between -1 and 38 days. For four major outcomes, the summary outcome postponement in days was as follows: cardiovascular mortality, 9.27 days (95% CI: 3.6 to 14.91; I² = 72%; 9 trials) non-vascular and non-cardiovascular mortality, 1.5 days (95% CI: -2.2 to 5.3; I² = 0%; 6 trials) any myocardial infarction 18.0 days (95% CI; 12.1 to 24.1; I² = 92%; 15 trials); and any stroke, 6.1 days (95% CI; 2.86 to 9.39; I² = 66%; 14 trials).

Conclusion: Statin treatment provided a small, average postponement of cardiovascular outcomes during trial duration.

Keywords: cardiovascular endpoints; cholesterol; effect measures; meta-analysis; outcome postponement; statins.