TDNet Discover

Background: Statins are the most prescribed medication in the United States, and their prevalence is only increasing to combat cardiovascular disease. The evidence-based medical community, professional organizations, and clinical guidelines strongly support their efficacy, and healthcare providers are held accountable by quality measures that ensure their status as a first-line intervention. However, many patients resist these medications and fail to adhere to their prescriptions due to perceived side effects or a bias against them. Purpose: The purpose of our study was to review the scientific literature on statins to try and quantify their relative and absolute benefit in minimizing major cardiac events, strokes, and allcause mortality. This would help us make informed clinical decisions in our careers for our patients. Methods: Three researchers systematically reviewed meta-analyses to address the research question. A data extraction tool was utilized to perform the qualitative analysis of the key metrics included in 8 meta-analyses comprising 126 studies with 1,158,689 participants. The individual studies did not directly report several important data points, but we derived these numbers using basic statistical formulas where possible. When statistical significance was not demonstrated, we assumed non-significant values. Results: Five studies included stroke/cerebrovascular events as an outcome, with a relative benefit ranging from 14%-25% and absolute benefit ranging from 0.39%-1%, while 1 of the studies did not report absolute stroke reduction. Seven studies reported major coronary events or myocardial infarction outcomes with relative benefit ranging from 16%-33% and absolute benefit ranging from 1.3%-3.6%. The all-cause mortality benefit was measured in all 7 studies with a relative benefit ranging from 8%-32% and an absolute benefit ranging from .35%-3.10%, iv but 4 studies failed to report the absolute benefit. The number needed to treat (NNT) was reported in 3 studies, and the NNT was calculated manually for the other 4 studies. NNT and absolute risk reduction (ARR) were most significant for major coronary events, all-cause mortality, and stroke, respectively. NNTs ranged from 28-118 for major coronary events, from 21-286 for all-cause mortality, and stroke from 58-256. Importantly, 5 out of the 7 studies did not directly report the ARR or NNT in their results. Conclusion: Statins appear to facilitate a persistent improvement in all three categories of stroke, major coronary event, and all-cause mortality in many of the reported outcomes, but a significant proportion of absolute benefit data was not reported. As a result, it is difficult to measure the clinical benefit of statins quantitatively.