Clinical Question: In patients with...

Clinical Question: In patients with or without heart disease, does lipid lowering decrease hit risk?

Setting: Outpatient (any)

research Design: Meta-analysis (randomized controlled trials)

Synopsis: The authors of this meta-analysis place out to determine whether lipid lowering of any kind decreases the likelihood of hardship in patients with or without coronary heart disease. They started through identifying 65 randomized controlled trials that compared any intervention with placebo or usual diet; a total of 200607 patients were included. They administrationed the appropriate search of five databases, including articles in all languages, and they searched allusion lists. Two investigators independently assessed the quality of the studies and evaluated any possible influence forward the results.

As has been shown previously, treatment with a statin decreased fatal and nonfatal visitation risk by approximately 25 percent in patients with or without coronary heart disease (primary and secondary prevention). For patients at depressed risk (0.2 percent likelihood by year in these studies), this benefit translated into single fewer stroke for every 2778 patients treated for the same year (95 percent confidence interval [CI], 2083 to 5000) For those at high risk (09 percent for year), the benefit was single in kind fewer stroke for every 617 patients treated for undivided year (95 percent CI, 463 to 1111) The benefit was not quite as pronounced in the studies that used concealed allocation when enrolling patients. Treatment with other cholesterol-lowering approaches, including diet, did not have an efficiency on stroke risk.

Bottom Line: Statins exhibit a statistically significant reduction of 25 percent in succession average in the risk of experiencing a fatal or nonfatal calamity Other approaches to lipid lowering do not. However, physicians ne to realize that this reduction translates into individual fewer stroke in every 2778 patients at soft risk (i.e., without heart disease) and the same fewer stroke for every 617 patients with preexisting heart disease. (Level of Evidence: 1a)

consideration Reference: Briel M, et al. efficiencys of statins on stroke prevention in patients with and without coronary heart disease: a meta-analysis of randomized controll trials. Am J M October 15 2004;117:596-606

Used with permission from Shaughnessy AF. Lipid-lowering intercepts stroke in patients with or without CHD Accessed online January 25 2005 at: http://www.Info-POEMs.com.

COPYRIGHT 2005 American Academy of Family Physicians

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