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Statines 72. Cholesterol Treatment Trialists’ Collaboratiors. Lancet 2005; 366:1267-78 Baigent. ACPJC 2006;144:62 Design N/n Population Sd Interventions MA N=14, n=90.056 -mean pre-treatment LDL: 3.03 mmol/l to 4.96 mmol/l -All RCTs studying statins 5y -Statins -Control Regardless of starting LDL cholesterol level, the authors found that each 39 mg/dL (1.0 mmol/L) statin-induced reduction in LDL cholesterol was associated with a one-eighth relative reduction in all-cause mortality and a one-fifth relative reduction in major vascular events. While this was true for relative risk, it was not true for absolute risk. The absolute risk reduction (ARR) for MI or coronary death was 3.8% for LDL cholesterol > 173 mg/dL (> 4.47 mmol/L) (number needed to treat [NNT] = 28), 2.3% for LDL cholesterol 135 to 173 mg/dL (3.49 to 4.47 mmol/L) (NNT = 43), and 1.9% for LDL cholesterol < 135 mg/dL (< 3.49 mmol/L) (NNT = 53), suggesting diminishing, although still important, benefits at lower LDL cholesterol levels. Subanalyses Post-MI Major coronary events 11.7% (statins) vs 15.4% RR=0.78 (95%CI 0.74 to 0.84) Other coronary artery disease 8.7% (statins) vs 11.4% RR= 0.77 (0.68 to 0.87) RRRs: reduction per ↓ 1 mmol/l (39 mg/dl) LDL at 1 year
-Statines - • ↓ mortaliteit en ernstige cardiovasculaire events (NNT/5j= 27) • RRR onafhankelijk van basiswaarde – Voor “any major coronary event”: RRR 23% per 40 mg/dl LDL daling – Absolute risicoverschillen wel afhankelijk van basiswaarde “any major coronary event” (MI of CV dood) • Globaal: NNT/5j = 45 • LDL > 173 mg/dL: NNT/5j = 28 • LDL 135 tot 173 mg/dL: NNT/5j = 43 • LDL < 135 mg/dL: NNT/5j = 53 Conclusie Domus Medica: Voor hoogrisicopatiënten van middelbare leeftijd geeft lipidenverlagende therapie met statines winst in cardiovasculaire sterfte en morbiditeit, ook als de patiënt een ‘normaal’ lipidengehalte heeft Boland. Aanbeveling Globaal cardiovasculair risicobeer. Domus Medica 2007 www.<strong>farmaka</strong>.be Project Farmaka
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