Re: Should a women get a statin
- From: "Juhana Harju" <nope@xxxxxxx>
- Date: Tue, 30 Oct 2007 23:26:27 +0200
Jim Chinnis wrote:
bigvince <Vince.Miraglia@xxxxxxxxx> wrote in part:
CLINICIAN'S CORNER
Drug Treatment of Hyperlipidemia in Women
Judith M. E. Walsh, MD, MPH; Michael Pignone, MD, MPH
JAMA. 2004;291:2243-2252.
Context Several clinical trials have evaluated the effects of lipid-
lowering medications on coronary heart disease (CHD). Many of the
trials have not included enough women to allow sex-specific analyses
or have not reported results in women separately.
Objectives To assess and synthesize the evidence regarding drug
treatment of hyperlipidemia for the prevention of CHD events in women
and to conduct a meta-analysis of the effect of drug treatment on
mortality.
Data Sources We searched MEDLINE, the Cochrane Database, and the
Database of Abstracts of Reviews of Effectiveness for articles
published from 1966 through December 2003. We reviewed reference
lists of articles and consulted content experts.
Study Selection and Data Extraction Studies of outpatients that had
a treatment duration of at least 1 year, assessed the impact of lipid
lowering on clinical outcomes, and reported results by sex were
included. Outcomes evaluated were total mortality, CHD mortality,
nonfatal myocardial infarction, revascularization, and total CHD
events. Summary estimates of the relative risks (RRs) with therapy
were calculated using a random-effects model for patients with and
without a previous history of cardiovascular disease.
Data Synthesis Thirteen studies were included. Six trials included a
total of 11 435 women without cardiovascular disease and assessed the
effects of lipid-lowering medications. Lipid lowering did not reduce
total mortality (RR, 0.95; 95% confidence interval [CI], 0.62-1.46),
CHD mortality (RR, 1.07; 95% CI, 0.47-2.40), nonfatal myocardial
infarction (RR, 0.61; 95% CI, 0.22-1.68), revascularization (RR,
0.87; 95% CI, 0.33-2.31), or CHD events (RR, 0.87; 95% CI,
0.69-1.09). However, some analyses were limited by too few CHD
events in the available trials. Eight trials included 8272 women
with cardiovascular disease and assessed the effects of
lipid-lowering medications. Lipid lowering did not reduce total
mortality in women with cardiovascular disease (RR, 1.00; 95% CI,
0.77-1.29). However, lipid lowering reduced CHD mortality (RR, 0.74;
95% CI, 0.55-1.00), nonfatal myocardial infarction (RR, 0.71; 95%
CI, 0.58-0.87), revascularization (RR, 0.70; 95% CI, 0.55-0.89), and
total CHD events (RR, 0.80; CI, 0.71-0.91).
Conclusions For women without cardiovascular disease, lipid lowering
does not affect total or CHD mortality. Lipid lowering may reduce CHD
events, but current evidence is insufficient to determine this
conclusively. For women with known cardiovascular disease, treatment
of hyperlipidemia is effective in reducing CHD events, CHD mortality,
nonfatal myocardial infarction, and revascularization, but it does
not affect total mortality. '
Seems to be weak evidence of benefit
Thanks Vince
It only covered studies completed through 2003.
Women with heart disease are older than men with heart disease. It is
hard to improve mortality in the very elderly because of mortality
substitution effects.
Note that the mortality confidence interval is 0.77-1.29, hardly
conclusive of no mortality benefit. Later studies have also changed
this.
Here is a more recent meta-analysis.
Curr Med Res Opin. 2007 Mar;23(3):565-74.
Impact of gender on statin efficacy.
Dale KM, Coleman CI, Shah SA, Patel AA, Kluger J, White CM.
University of Connecticut School of Pharmacy, Storrs, CT, USA.
OBJECTIVE: To determine the impact of statin therapy on the combined endpoint of cardiovascular events in women and men separately. RESEARCH DESIGN AND METHODS: A systematic literature search through May 2006 was conducted to identify randomized, controlled statin trials evaluating the gender specific incidence of cardiovascular events. Weighted averages were reported as relative risks (RRs) with 95% confidence intervals (CI) calculated via random-effects model. MAIN OUTCOME MEASURES: The primary outcome measured was a composite endpoint of all cardiovascular events. Secondary outcomes measured included death, myocardial infarction (MI), and stroke. RESULTS: Fifteen trials were included in this meta-analysis. Cardiovascular events were reduced in men (RR 0.76 [95% CI 0.70, 0.81]) and women (RR 0.79 [95% CI 0.69, 0.90]). Reductions in mortality, MI, and stroke predominantly contributed to the reduction in cardiovascular events in men taking statins. Women did not have a reduction in mortality or stroke, suggesting that the reductions in cardiac events may have been predominantly due to reductions in need for revascularization and/or unstable angina. CONCLUSIONS: Statins reduced the risk of cardiovascular events in men and women, but women on statins may not have reductions in mortality and stroke like their male counterparts. PMID: 17355737
http://tinyurl.com/398elz
--
Juhana
http://ruohikolla.blogspot.com/
.
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