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Systematic review
Statins are not associated with a decrease in all cause mortality in a high-risk primary prevention setting
  1. Bernhard M Kaess1,
  2. Ramachandran S Vasan2
  1. 1Framingham Heart Study and Klinik und Poliklinik für Innere Medizin II, University of Regensburg, Regensburg, Germany
  2. 2Framingham Heart Study and Section of Preventive Medicine and Epidemiology, Boston University School of Medicine, Boston, Massachusetts, USA
  1. Correspondence to Bernhard M Kaess
    73 Mount Wayte Avenue, Suite 2, Framingham, MA 01702–5803, USA; kaess{at}

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Low-density lipoprotein (LDL) cholesterol (LDL-C) is a risk factor for cardiovascular disease (CVD). Statins (3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitors) lower LDL-C concentrations by about 30–50% and have been shown to reduce mortality in patients with prevalent CVD. However, it is not clear whether statin treatment is beneficial in a primary prevention setting, that is in people without prevalent CVD who are at relatively lower risk. The recent results of the JUPITER trial1 have fuelled an intense debate whether statins should be given for primary prevention of CVD.


The authors performed a literature search in MEDLINE and Cochrane Collaboration databases to identify randomised controlled trials of statin use comprising patients without prevalent CVD at baseline. For trials partly containing CVD patients, the authors obtained tabular data for the individuals without a history of CVD. A meta-analysis was performed using both random effects and fixed effects models. The primary outcome of interest …

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  • Competing interests None.