Clinical benefit of cholesterol lowering treatments: meta-analysis of randomized therapeutic trials

Primary prevention: A meta-analysis of the 7 available randomized cholester ol lowering trials (2 on statins, 2 on fibrates, 2 on resins and 1 on diet) demonstrates a significant 24% relative reduction in the frequency of fata l and non-fatal coronary events, leading to a significant 14% relative redu ction in coronary disease related mortality. For total mortality the statin trials were not comparable with other treatments where there was a trend t o overmortality. With the 2 statin trials, there was a nonsignificant 13% r eduction in total mortality Secondary prevention: A meta-analysis of the 13 available randomized trials (3 with clofribrate, 1 with gemfibrozil, 2 with nicotinic acid, and 4 with diet) showed a significant 21% reduction in the frequency of fatal and non -fatal coronary events, coronary mortality and total mortality. For total m ortality, only the result of the 2 statin trials was significant (-20%). Beneficial effect of statins, absolute values: Measured as the number of pa tients to treat for 5 years in order to avoid 1 event (NNT), there is a cli nically pertinent benefit of secondary prevention (NNT = 15 for events, NNT = 30 for coronary mortality). The absolute value is weaker when patients w ith minimally elevated cholesterol levels are included. For primary prevent ion, the absolute value is low with NNT = 44 for events and NNT = 300 for c oronary mortality in addition, as these results were obtained in trials inc luding populations with a much higher risk than the general French populati on, the absolute beneficial effect may not be pertinent in France except in high-risk patients who pre sent, in addition to a high cholesterol level, other cardiovascular risk factors.