Statins for the Primary Prevention of Coronary Heart Disease

OBJECT: The purpose of this study was to fully assess the role of statins in the primary prevention of coronary heart disease (CHD). METHODS: We searched six databases (PubMed, the Cochrane Library, Web of Science, China National Knowledge Infrastructure, Wanfang Database, and Chinese Scientific Journal Database) to identify relevant randomized controlled trials (RCTs) from inception to 31 October 2017. Two review authors independently assessed the methodological quality and analysed the data using Rev Man 5.3 software. Risk ratios and 95% confidence intervals (95% CI) were pooled using fixed/random-effects models. Funnel plots and Begg's test were conducted to assess publication bias. The quality of the evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. RESULTS: Sixteen RCTs with 69159 participants were included in this review. Statins can effectively decrease the occurrence of angina (RR=0.70, 95% CI: 0.58~0.85, I(2) =0%), nonfatal myocardial infarction (MI) (RR=0.60, 95% CI: 0.51~0.69, I(2) =14%), fatal MI (RR=0.49, 95% CI: 0.24~0.98, I(2) =0%), any MI (RR=0.53, 95% CI: 0.42~0.67, I(2) =0%), any coronary heart events (RR=0.73, 95% CI: 0.68~0.78, I(2)=0%), coronary revascularization (RR=0.66, 95% CI: 0.55~0.78, I(2) = 0%), and any cardiovascular events (RR=0.77, 95% CI: 0.72~82, I(2) = 0%). However, based on the current evidence, there were no significant differences in CHD deaths (RR=0.82, 95% CI: 0.66~1.02, I(2)=0%) and all-cause mortality (RR=0.88, 95% CI: 0.76 ~1.01, I(2) =58%) between the two groups. Additionally, statins were more likely to result in diabetes (RR=1.21, 95% CI: 1.05~1.39, I(2) =0%). There was no evidence of publication biases, and the quality of the evidence was considered moderate. CONCLUSION: Statins seemed to be beneficial for the primary prevention of CHDs but have no effect on CHD death and all-cause mortality.