Meta-analysis of the cardiovascular benefits of intensive lipid lowering with statins

SummaryOR 0.790.980.870.830.750.330.51 0.8 0.2 0.4 0.6 0.8 1 1.2 Study A-Z trial (4)PROVE-IT (5)IDEAL (6)SPARCL (7)TNT (8)SAGE (9)JUPITER (10) SummaryOR 0.880.860.770.590.790.720.53 0.74 0.5 0.6 0.7 0.8 0.9 1 Study A-Z trial (4)PROVE-IT (5)IDEAL (6)SPARCL (7)TNT (8)SAGE (9)JUPITER (10) SummaryOR 0.740.780.980.790.790.390.83 0.84 0.2 0.4 0.6 0.8 1 1.2 Liver enzyme elevation Treatment discontinuation due to side effects Study A-Z trial (4)PROVE-IT (5)IDEAL (6)TNT (8)SAGE (9)JUPITER (10)Summary OR 1.190.892.431.390.840.981.2 1 1.5 2 2.5 Study A-Z trial (4)PROVE-IT (5)IDEAL (6)TNT (8)SAGE (9)JUPITER (10)Summary OR 2.4 3.0 8.8 6.819.8 1.44 51015 2025 AB C Stroke events DEFigure 2. Odds ratios for statin treatment effects and safety. (A) Stroke events, (B) Major coronary events, (C) Cardiovascu-lar ⁄coronary heart deaths, (D) Liver enzyme elevation, and (E) Treatment discontinuation because of side effects. Table 3 Meta-analysis of safety data on statin treatmentStudyLiver enzyme elevation* Treatment discontinuation due to side effectsLess Intensive Intensive Odds Ratios(95% confidenceintervals)Less Intensive Intensive Odds Ratios(95% confidenceintervals)Events (%) Events (%) Events (%) Events (%)A-Z trial (4) 8 (0.4) 19 (0.8) 2.35 (1.03–5.38) 34 (1.5) 41 (1.8) 1.19 (0.75–1.88)PROVE-IT (5) 23 (1.1) 69 (3.3) 3.01 (1.87–4.85) 681 (33.0) 638 (30.4) 0.89 (0.78–1.01)IDEAL (6) 7 (0.2) 61 (1.4) 8.84 (4.04–19.35) 186 (4.2) 426 (9.6) 2.43 (2.04–2.91)SPARCL (7) NA NA NA NA NA NATNT (8) 9 (0.2) 60 (1.2) 6.75 (3.35–13.62) 265 (5.3) 360 (7.2) 1.39 (1.18–1.64)SAGE (9) 1 (0.2) 19 (4.3) 19.76 (2.63–148.23) 103 (23.1) 90 (20.2) 0.84 (0.61–1.16)JUPITER (10) 17 (0.2) 23 (0.3) 1.35 (0.72–2.54) 1377 (15.5) 1352 (15.2) 0.98 (0.90–1.06)ALL studies included 65 (0.1) 251 (0.5) 3.96 (2.08–7.53) 2646 (3.8) 2907 (6.3) 1.20 (0.88–1.64)Exclude JUPITER 48 (0.1) 228 (0.8) 4.96 (2.73–9.01) 1269 (3.0) 1555 (5.5) 1.25 (0.82–1.92)Exclude SPARCL and JUPITER NA NA*Defined by an elevation in AST or ALT levels of more than three times upper limit of reference range.