CardioExchange Archive

Study Raises Questions About Statins for Primary Prevention: A new meta-analysis raises questions about the benefits of statins when given to people without a clinical history of heart disease. Kausik Ray and colleagues, in a paper in Archives of Internal Medicine, analyzed data from 65,229 subjects in 11 studies. There were 2793 deaths in the studies, 1447 among those taking placebo and 1346 among those taking a statin. The risk ratio of 0.91 did not achieve statistical significance (95% CI, 0.83-1.101). They also observed that baseline LDL levels did not appear to have an impact on mortality. The authors acknowledge that a larger benefit might have been observed with more prolonged followup.
Their findings, write the authors, “further reinforce the notion that lowering lipid levels in a very high-risk primary prevention population is not likely to be harmful, but any mortality benefits are likely to be more modest than previously perceived. As a corollary, however, it may be inferred that in even more lower risk populations (such as subjects at low CVD risk prescribed statins for primary prevention of CVD), the benefits of mortality reduction are likely to be even more modest than observed in this meta-analysis, at least in the short term.”

JUPITER Under Attack: Two papers in Archives of Internal Medicine are highly critical of JUPITER. Michel de Lorgeril and colleagues raise a number of troubling questions concerning the conduct of the trial and conflicts of interest. Among their many criticisms, they say the trial should not have been stopped early because this had the effect of magnifying the benefit of the study drug. They also discuss the paucity of data on cardiovascular mortality and troubling inconsistencies with the ratio of fatal MI to nonfatal MI in the trial. They note that 9 of the 14 authors of JUPITER had financial ties to the sponsor. The authors write that “the results of the trial do not support the use of statin treatment for primary prevention of cardiovascular diseases and raise troubling questions concerning the role of commercial sponsors.”
In the second paper on JUPITER, Sanjay Kaul, Ryan Morrissey, and George Diamond offer their own perspective on the trial. They conclude that it does not provide any justification for routine measurement of hsCRP and agree with de Lorgeril et al that the benefit observed in JUPITER was quite likely magnified because of the early termination of the trial. However, they write that the beneficial effect is “real,” although they caution: “do not expect 50% risk reductions in outcomes.”