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June 25, 2012

Statin Therapy in the Prevention of Recurrent Cardiovascular Events: A Sex-Based Meta-analysis

Author Affiliations

Author Affiliations: Department of Neurology, Neurological Institute, Columbia University, New York, New York (Dr Gutierrez); Robert Stempel School of Public Health, Florida International University, Miami (Dr Ramirez); Departments of Neurology (Drs Rundek and Sacco) and Epidemiology and Genomics (Dr Sacco), Miller School of Medicine, University of Miami, Miami, Florida.

Arch Intern Med. 2012;172(12):909-919. doi:10.1001/archinternmed.2012.2145

Background The effect of statins on the prevention of cardiovascular events is well demonstrated. Whether this protective effect is equal for women and men remains less well established. Our objective was to evaluate if statin therapy is equally effective in decreasing recurrent cardiovascular events in women and men.

Data Sources Randomized clinical trials were searched in PubMed using as indexing terms (statins OR cholesterol lowering medications) AND (cardiovascular events OR stroke OR myocardial infarction OR cardiovascular death).

Study Selection We included randomized, double-blinded, placebo-controlled trials evaluating statins for secondary prevention of cardiovascular events. Studies with an open-label design and observational studies were excluded.

Data Extraction The earliest citation was used to determine the characteristic of the studied population and the methodology. All subsequent citations corresponding to the trial were evaluated for outcome rates by sex.

Data Synthesis Eleven trials representing 43 193 patients were included in the analysis. Overall, statin therapy was associated with a reduced risk of cardiovascular events in all outcomes for women (relative risk [RR], 0.81 [95% CI, 0.74-0.89]) and men (RR, 0.82 [95% CI, 0.78-0.85]). However, they did not reduce all-cause mortality in women vs men (RR, 0.92 [95% CI, 0.76-1.13] vs RR, 0.79 [95% CI, 0.720.87]) or stroke (RR, 0.92 [95% CI, 0.76-1.10] vs RR, 0.81 [95% CI, 0.72-0.92]).

Conclusions Statin therapy is an effective intervention in the secondary prevention of cardiovascular events in both sexes, but there is no benefit on stroke and all-cause mortality in women.