The effect of statins on cardiovascular outcomes by smoking status: A systematic review and meta-analysis of randomized controlled trials.

Autor: Ursoniu S; Department of Functional Sciences, Discipline of Public Health, 'Victor Babes' University of Medicine and Pharmacy, Timisoara, Romania., Mikhailidis DP; Department of Clinical Biochemistry, Royal Free Campus, University College London Medical School, University College London (UCL), London, UK., Serban MC; Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA; Department of Functional Sciences, Discipline of Pathophysiology, 'Victor Babes' University of Medicine and Pharmacy, Timisoara, Romania., Penson P; School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Liverpool, UK., Toth PP; Preventive Cardiology, CGH Medical Center, Sterling, Illinois, USA; The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA., Ridker PM; Center for Cardiovascular Disease Prevention, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA., Ray KK; Department of Primary Care and Public Health, School of Public Health, Imperial College London, UK., Kees Hovingh G; Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands., Kastelein JJ; Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands., Hernandez AV; Health Outcomes and Clinical Epidemiology Section, Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA; School of Medicine, Universidad Peruana de Ciencias Aplicadas (UPC), Lima, Peru., Manson JE; Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA., Rysz J; Department of Hypertension, Chair of Nephrology and Hypertension, Medical University of Lodz, Poland., Banach M; Department of Hypertension, Chair of Nephrology and Hypertension, Medical University of Lodz, Poland; Cardiovascular Research Centre, University of Zielona Gora, Zielona Gora, Poland; Polish Mother's Memorial Hospital Research Institute, Lodz, Poland. Electronic address: maciejbanach@aol.co.uk.
Jazyk: angličtina
Zdroj: Pharmacological research [Pharmacol Res] 2017 Aug; Vol. 122, pp. 105-117. Date of Electronic Publication: 2017 Jun 09.
DOI: 10.1016/j.phrs.2017.06.002
Abstrakt: Smoking is an important risk factor for cardiovascular disease (CVD) morbidity and mortality. The impact of statin therapy on CVD risk by smoking status has not been fully investigated. Therefore we assessed the impact of statin therapy on CVD outcomes by smoking status through a systematic review of the literature and meta-analysis of available randomized controlled trials (RCTs). The literature search included EMBASE, ProQuest, CINAHL and PUBMED databases to 30 January 2016 to identify RCTs that investigated the effect of statin therapy on cumulative incidence of major CVD endpoints (e.g. non-fatal myocardial infarction, revascularization, unstable angina, and stroke). Relative risks (RR) ratios were calculated from the number of events in different treatment groups for both smokers and non-smokers. Finally 11 trials with 89,604 individuals were included. The number of smokers and non-smokers in the statin groups of the analyzed studies was 8826 and 36,090, respectively. The RR for major CV events was 0.73 (95% confidence interval [CI]: 0.67-0.81; p<0.001) in nonsmokers and 0.72 (95%CI: 0.64-0.81; p<0.001) in smokers. Moderate to high heterogeneity was observed both in non-smokers (I 2 =77.1%, p<0.001) and in smokers (I 2 =51.6%, p=0.024) groups. Smokers seemed to benefit slightly more from statins than non-smokers according to the number needed to treat (NNT) analysis (23.5 vs 26.8) based on RRs applied to the control event rates. The number of avoided events per 1000 individuals was 42.5 (95%CI: 28.9-54.6) in smokers and 37.3 (95%CI: 27.2-46.4) in non-smokers. In conclusion, this meta-analysis suggests that the effect of statins on CVD is similar for smokers and non-smokers, but in terms of NNTs and number of avoided events, smokers seem to benefit more although non-significantly.
(Copyright © 2017 Elsevier Ltd. All rights reserved.)
Databáze: MEDLINE
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