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Efficacy and safety evaluation of intensive statin therapy in older patients with coronary heart disease: a systematic review and meta-analysis

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Abstract

Purpose

To reveal and evaluate the efficacy and safety of intensive statin therapy in older patients (age ≥ 65 years) with coronary heart disease (CHD).

Methods

Electronic databases were searched for randomized controlled trials (RCTs) that involved intensive statin therapy use in older patients with CHD. Data was extracted and used to calculate risk ratios (RR) by software Revman 5.1.

Results

Five RCTs and 11,132 patients were included in. Compared with non-intensive statin therapy, intensive statin therapy had significant effect on reducing low density lipoprotein cholesterol (LDL-C) levels (55.4 %) and total cholesterol (TC) and triglyceride (Tg). Although the results showed that intensive statin therapy had no superior effect on reduction of mortality (both all-cause mortality [RR = 0.97, p = 0.65] and cardiac death [RR = 0.95, p = 0.57]) and cardiac arrest (RR = 1.09, p = 0.81), it possessed significant effects on prevention of nonfatal myocardial infarction (MI) (RR = 0.78, p = 0.008), stroke (RR = 0.72, p = 0.02) and coronary revascularization (RR = 0.69, p = 0.007). In terms of side effects, intensive statin therapy was associated with small absolute increase in incidence of drug discontinuation, due to adverse events (3.9 %) and liver enzymes abnormalities (1.7 %). And the occurrence rates of myopathy, rhabdomyolysis and creatine kinase (CK) elevation were very low.

Conclusions

This results show that intensive statin therapy has excellent effects on reduction of serum lipid level including LDL-C, TC, Tg, and also on prevention of nonfatal MI, stroke and coronary revascularization with small absolute increased risk of side effects. Our analysis supports the use of intensive statin therapy in patients ≥ 65 years old with CHD.

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Abbreviations

CHD:

Coronary heart disease

RCTs:

Randomized controlled trials

RR:

Risk ratio

CI:

Confidence Interval

HMG-CoA:

3-hydroxy-3-methylglutaryl coenzyme A

LDL-C:

Low density lipoprotein cholesterol

TC:

Total cholesterol

Tg:

Triglyceride

MI:

Myocardial infarction

HDL-C:

High density lipoprotein cholesterol

AST:

Aspirate aminotransferase

ALT:

Alanine aminotransferase

CK:

Creatine kinase

NR:

Not reported

ULN:

Upper limit of normal

References

  1. Hoeg JM, Brewer HJ (1987) 3-Hydroxy-3-methylglutaryl–coenzyme A reductase inhibitors in the treatment of hypercholesterolemia [J]. JAMA 258(24):3532–6

    Article  PubMed  CAS  Google Scholar 

  2. Mantell G (1989) Lipid lowering drugs in atherosclerosis–the HMG-CoA reductase inhibitors [J]. Clin Exp Hypertens A 11(5–6):927–41

    Article  PubMed  CAS  Google Scholar 

  3. Hsu I, Spinler SA, Johnson NE (1995) Comparative evaluation of the safety and efficacy of HMG-CoA reductase inhibitor monotherapy in the treatment of primary hypercholesterolemia[J]. Ann Pharmacother 29(7–8):743–59

    PubMed  CAS  Google Scholar 

  4. Byington RP, Jukema JW, Salonen JT et al (1995) Reduction in cardiovascular events during pravastatin therapy. Pooled analysis of clinical events of the Pravastatin Atherosclerosis Intervention Program [J]. Circulation 92(9):2419–25

    Article  PubMed  CAS  Google Scholar 

  5. Dupuis J, Tardif JC, Cernacek P et al (1999) Cholesterol reduction rapidly improves endothelial function after acute coronary syndromes. The RECIFE (reduction of cholesterol in ischemia and function of the endothelium) trial [J]. Circulation 99(25):3227–33

    Article  PubMed  CAS  Google Scholar 

  6. Alber HF, Frick M, Süssenbacher A et al (2007) Effect of atorvastatin on peripheral endothelial function and systemic inflammatory markers in patients with stable coronary artery disease[J]. Wien Med Wochenschr 157(3–4):73–8

    Article  PubMed  Google Scholar 

  7. Oka H, Ikeda S, Koga S et al (2008) Atorvastatin induces associated reductions in platelet P-selectin, oxidized low-density lipoprotein, and interleukin-6 in patients with coronary artery diseases[J]. Hear Vessel 23(4):249–56

    Article  Google Scholar 

  8. Josan K, Majumdar SR, McAlister FA (2008) The efficacy and safety of intensive statin therapy: a meta-analysis of randomized trials [J]. CMAJ 178(5):576–84

    Article  PubMed  Google Scholar 

  9. Baigent C, Blackwell L, Emberson J et al (2010) Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from 170,000 participants in 26 randomised trials[J]. Lancet 376(9753):1670–81

    Article  PubMed  CAS  Google Scholar 

  10. Olsson AG, Schwartz GG, Szarek M et al (2007) Effects of high-dose atorvastatin in patients > or =65 years of age with acute coronary syndrome (from the myocardial ischemia reduction with aggressive cholesterol lowering [MIRACL] study) [J]. Am J Cardiol 99(5):632–5

    Article  PubMed  CAS  Google Scholar 

  11. Deedwania P, Stone PH, Bairey Merz CN et al (2007) Effects of intensive versus moderate lipid-lowering therapy on myocardial ischemia in older patients with coronary heart disease: results of the Study Assessing Goals in the Elderly (SAGE) [J]. Circulation 115(6):700–7

    Article  PubMed  CAS  Google Scholar 

  12. Wenger NK, Lewis SJ, Herrington DM et al (2007) Outcomes of using high- or low-dose atorvastatin in patients 65 years of age or older with stable coronary heart disease [J]. Ann Intern Med 147(1):1–9

    Article  PubMed  Google Scholar 

  13. Koren MJ, Feldman T, Mendes RA (2009) Impact of high-dose atorvastatin in coronary heart disease patients age 65 to 78 years [J]. Clin Cardiol 32(5):256–63

    Article  PubMed  Google Scholar 

  14. Tikkanen MJ, Holme I, Cater NB et al (2009) Comparison of Efficacy and Safety of Atorvastatin (80 mg) to Simvastatin (20 to 40 mg) in Patients Aged <65 Versus >65 Years With Coronary Heart Disease (from the Incremental Decrease through Aggressive Lipid Lowering [IDEAL] Study) [J]. Am J Cardiol 103(5):577–582

    Article  PubMed  CAS  Google Scholar 

  15. Baigent C, Keech A, Kearney PM et al (2005) Cholesterol Treatment Trialists’ Collaborators. Efficacy and safety of cholesterol-lowering treatment: prospective meta-analysis of data from 90 056 participants in 14 randomized trials of statins [J]. Lancet 366(9493):1267–78

    Article  PubMed  CAS  Google Scholar 

  16. Grundy SM, Cleeman JI, Merz CN et al (2004) Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III guidelines[J]. Circulation 110(2):227–39

    Article  PubMed  Google Scholar 

  17. de Lemos JA, Blazing MA, Wiviott SD et al (2004) Early intensive vs a delayed conservative simvastatin strategy in patients with acute coronary syndromes: phase Z of the A to Z trial [J]. JAMA 292(11):1307–16

    Article  PubMed  Google Scholar 

  18. Rouleau J (2005) Improved outcome after acute coronary syndromes with an intensive versus standard lipid-lowering regimen: results from the Pravastatin or Atorvastatin Evaluation and Infection Therapy-Thrombolysis in Myocardial Infarction 22 (PROVE IT-TIMI 22) trial [J]. Am J Med 118(12A):28–35

    Article  PubMed  Google Scholar 

  19. LaRosa JC, Grundy SM, Waters DD et al (2005) Intensive lipid lowering with atorvastatin in patients with stable coronary disease [J]. N Engl J Med 352(14):1425–35

    Article  PubMed  CAS  Google Scholar 

  20. Pedersen TR, Faergeman O, Kastelein JJ et al (2005) High-dose atorvastatin vs usual-dose simvastatin for secondary prevention after myocardial infarction: the IDEAL study: a randomized controlled trial [J]. JAMA 294(19):2437–45

    Article  PubMed  CAS  Google Scholar 

  21. Mills EJ, O’Regan C, Eyawo O et al (2011) Intensive statin therapy compared with moderate dosing for prevention of cardiovascular events: a meta-analysis of >40 000 patients [J]. Eur Hear J 32(11):1409–1415

    Article  CAS  Google Scholar 

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Competing interests

We have no financial relationships with any organizations and parties that may have interests in this paper. All the authors declare that they have no conflict of interests.

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Authors and Affiliations

  1. Cardiovascular Department, The Second Affiliated Hospital of Chongqing Medical University, No.76, Linjiang Road, Yuzhong district, Chongqing, People’s Republic of China, 400010

    Y. L. Yan, B. Qiu, L. J. Hu, X. D. Jing, Y. J. Liu, S. B. Deng, J. L. Du & Q. She

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  1. Y. L. Yan
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  2. B. Qiu
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  3. L. J. Hu
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  4. X. D. Jing
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  5. Y. J. Liu
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  6. S. B. Deng
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  7. J. L. Du
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  8. Q. She
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Correspondence to Q. She.

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Yan, Y.L., Qiu, B., Hu, L.J. et al. Efficacy and safety evaluation of intensive statin therapy in older patients with coronary heart disease: a systematic review and meta-analysis. Eur J Clin Pharmacol 69, 2001–2009 (2013). https://doi.org/10.1007/s00228-013-1570-0

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  • DOI: https://doi.org/10.1007/s00228-013-1570-0

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