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Executable file
Byrne, Paula, et al. ‘Evaluating the Association Between Low-Density Lipoprotein Cholesterol Reduction and Relative and Absolute Effects of Statin Treatment: A Systematic Review and Meta-Analysis’. JAMA Internal Medicine, Mar. 2022. Silverchair, https://doi.org/10.1001/jamainternmed.2022.0134.
Link:
2790055
Notes:
- No distinction between time-based and event-based stopping conditions.
- Relative risk and absolute risk are answering two different questions.
- Included many trials with chronic kidney failure and on hemodialysis (high risk with unclear potential benefit of lipid lowering).
- Unclear distinction between high and moderate risk populations, with high risk populations already having achieved significant lipid reductions.
- Authors assume linearity in the relationship between LDL and their endpoints (average 3-4 years versus 20 years, when the largest risk reductions seem to be achieved).
- Mixed primary and secondary prevention trials.
Conclusions:
The results of this meta-analysis suggest that the absolute risk reductions of treatment with statins in terms of all-cause mortality, myocardial infarction, and stroke are modest compared with the relative risk reductions, and the presence of significant heterogeneity reduces the certainty of the evidence. A conclusive association between absolute reductions in LDL-C levels and individual clinical outcomes was not established, and these findings underscore the importance of discussing absolute risk reductions when making informed clinical decisions with individual patients.
| Endpoints | Exposures | Populations | General | People |
|---|---|---|---|---|
| #coronary_heart_disease | #statins | #humans | #blood_lipids | |
| #all_cause_mortality | #LDL | #multinational | #disease | |
| #stroke | #serum_cholesterol | #clownery | ||
| #clown_papers |