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Pleiotropic Effects of Statins: Benefit Beyond Cholesterol Reduction?

A Meta-Regression Analysis

Jennifer G. Robinson, MD, MPH^_*,_*, Brian Smith, MS, PhD, Nidhi Maheshwari, MBBS^_* and Helmut Schrott, MD^_*

^_* Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa
Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, Iowa

View larger version (34K): [in a new window]   Figure 1 Flow diagram and trials excluded from the primary meta-analysis. CHD = coronary heart disease; LDL-C = low-density lipoprotein cholesterol; MI = myocardial infarction; RCT = randomized controlled trial.

View larger version (32K): [in a new window]   Figure 2 Estimated change in the five-year relative risk of non-fatal myocardial infarction or CHD death associated with mean LDL-C reduction for the diet, bile-acid sequestrant, surgery, and statin trials (dashed line) along with the 95% probability interval (dotted line). The solid line has a slope = 1. The crude risk estimates from the individual studies are plotted along with their associated 95% confidence intervals. The Sydney (26) trial is not shown but was included in the analysis. Statin trials are designated by the boldface symbols. CHD = coronary heart disease; LDL-C = low-density lipoprotein cholesterol. Study acronyms: MRC = Medical Research Council; LRC = Lipid Research Clinics; NHLBI = National Heart, Lung, and Blood Institute; POSCH = Program on the Surgical Control of the Hyperlipidemias; 4S = Scandinavian Simvastatin Survival Study; WOSCOPS = West of Scotland Coronary Prevention Study; CARE = Cholesterol and Recurrent Events study; LIPID = Long-Term Intervention with Pravastatin in Ischemic Disease; AF/TexCAPS = Air Force/Texas Coronary Atherosclerosis Prevention Study; HPS = Heart Protection Study; ALERT = Assessment of LEscol in Renal Transplantation; PROSPER = PROspective Study of Pravastatin in the Elderly at Risk; ASCOT-LLA = Anglo-Scandinavian Cardiac Outcomes Trial–Lipid Lowering Arm; CARDS = Collaborative Atorvastatin Diabetes Study.

View larger version (24K): [in a new window]   Figure 3 Estimated change in the five-year relative risk of stroke associated with mean LDL-C reduction for the statin trials* (dashed line) along with the 95% probability interval (dotted line). The solid line has a slope = 1. The crude risk estimates from the individual studies are plotted along with their associated 95% confidence intervals. LDL-C = low-density-lipoprotein cholesterol. Study acronyms: 4S = Scandinavian Simvastatin Survival Study; WOSCOPS = West of Scotland Coronary Prevention Study; CARE = Cholesterol And Recurrent Events study; LIPID = Long-Term Intervention with Pravastatin in Ischemic Disease; HPS = Heart Protection Study; PROSPER = PROspective Study of Pravastatin in the Elderly at Risk; ASCOT-LLA = Anglo-Scandinavian Cardiac Outcomes Trial–Lipid Lowering Arm; CARDS = Collaborative Atorvastatin Diabetes Study. *Only statin trials reported stroke incidence.