SynthesisBMC cardiovascular disorders2014

Effect of statins on cardiovascular events in patients with mild to moderate chronic kidney disease: a systematic review and meta-analysis of randomized clinical trials.

Xiao Zhang, Chun Xiang, Yu-Hao Zhou, An Jiang, Ying-Yi Qin, Jia He

Open access · goldFull text readMeta-AnalysisSystematic Review
In one paragraph

Synthesis in BMC cardiovascular disorders, 2014. The graph read 9 numbers from its abstract, feeding 2 cells of the map: it supports the treatment in 1. Cited by 15 papers, 3 of them syntheses that pooled it.

9numbers the graph read from it
1cell of the map it votes in
15citing papers in PubMed, 3 pooled it
5.0field-weighted citation impact, top 5% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

← favours the treatmentfavours the comparator →
0.51 · no effect
Cardiovascular eventsfavours the treatment · against placebo · ascvd, dyslipidemiafeeds one cell of the map
RR 0.660.52 to 0.83p = 0.001
The pooled RR for the effect of myocardial infarction in patients receiving statin therapy compared with that of the control treatment was 0.66 (RR, 0.66; 95% CI, 0.52-0.83; p = 0.001; Figure 4).

Read, but not usablea number the graph found but could not read as for or against

All-cause mortalitycomparator not stated · ascvd, dyslipidemiafeeds one cell of the map
RR 0.790.72 to 0.86
Overall, statin therapy resulted in a 24% reduction in the risk of cardiovascular disease (RR = 0.76,95% confidence interval [CI], 0.72- 0.80), a 21% reduction in the risk of total mortality (RR = 0.79,95% CI, 0.72-0.86), a 34% reduction in the risk of myocardial infarction (RR = 0.66,95% CI, 0.52-0.83), a 30% reduction in the risk of stroke (RR = 0.70,95% CI, 0.57-0.85), and a 17% reduction in the risk of cardiovascular mortality (RR = 0.83,95% CI, 0.73- 0.93).
All-cause mortalitycomparator not stated · ascvd, dyslipidemiafeeds one cell of the map
RR 0.790.72 to 0.86
The pooled results revealed that total mortality was significantly lower among patients undergoing stain therapy (RR, 0.79; 95% CI, 0.72-0.86; Figure 3) by using a random-effects model.
Cardiovascular eventscomparator not stated · ascvd, dyslipidemiafeeds one cell of the map
RR 0.830.73 to 0.93
Overall, statin therapy resulted in a 24% reduction in the risk of cardiovascular disease (RR = 0.76,95% confidence interval [CI], 0.72- 0.80), a 21% reduction in the risk of total mortality (RR = 0.79,95% CI, 0.72-0.86), a 34% reduction in the risk of myocardial infarction (RR = 0.66,95% CI, 0.52-0.83), a 30% reduction in the risk of stroke (RR = 0.70,95% CI, 0.57-0.85), and a 17% reduction in the risk of cardiovascular mortality (RR = 0.83,95% CI, 0.73- 0.93).
Cardiovascular eventscomparator not stated · ascvd, dyslipidemiafeeds one cell of the map
RR 0.700.57 to 0.85
Overall, statin therapy resulted in a 24% reduction in the risk of cardiovascular disease (RR = 0.76,95% confidence interval [CI], 0.72- 0.80), a 21% reduction in the risk of total mortality (RR = 0.79,95% CI, 0.72-0.86), a 34% reduction in the risk of myocardial infarction (RR = 0.66,95% CI, 0.52-0.83), a 30% reduction in the risk of stroke (RR = 0.70,95% CI, 0.57-0.85), and a 17% reduction in the risk of cardiovascular mortality (RR = 0.83,95% CI, 0.73- 0.93).
Cardiovascular eventscomparator not stated · ascvd, dyslipidemiafeeds one cell of the map
RR 0.710.45 to 1.12p = 0.139
Superior efficacy of statin therapy on cardiovascular events was found in the majority of subgroup analyses, except for patients with a baseline creatinine level ≥1.5 mg/dL (RR, 0.71; 95% CI, 0.45-1.12; p = 0.139; Table 2).
Cardiovascular eventscomparator not stated · ascvd, dyslipidemiafeeds one cell of the map
RR 0.660.52 to 0.83
Overall, statin therapy resulted in a 24% reduction in the risk of cardiovascular disease (RR = 0.76,95% confidence interval [CI], 0.72- 0.80), a 21% reduction in the risk of total mortality (RR = 0.79,95% CI, 0.72-0.86), a 34% reduction in the risk of myocardial infarction (RR = 0.66,95% CI, 0.52-0.83), a 30% reduction in the risk of stroke (RR = 0.70,95% CI, 0.57-0.85), and a 17% reduction in the risk of cardiovascular mortality (RR = 0.83,95% CI, 0.73- 0.93).
Cardiovascular eventscomparator not stated · ascvd, dyslipidemiafeeds one cell of the map
RR 0.760.72 to 0.80
Overall, statin therapy resulted in a 24% reduction in the risk of cardiovascular disease (RR = 0.76,95% confidence interval [CI], 0.72- 0.80), a 21% reduction in the risk of total mortality (RR = 0.79,95% CI, 0.72-0.86), a 34% reduction in the risk of myocardial infarction (RR = 0.66,95% CI, 0.52-0.83), a 30% reduction in the risk of stroke (RR = 0.70,95% CI, 0.57-0.85), and a 17% reduction in the risk of cardiovascular mortality (RR = 0.83,95% CI, 0.73- 0.93).
All-cause mortalitycomparator not stated · ascvd, dyslipidemiafeeds one cell of the map
RR 1.480.41 to 5.36p = 0.55
We noted that statin therapy had no effect on total mortality in patients with a history of cardiovascular disease (RR, 1.48; 95% CI, 0.41-5.36; p = 0.55), baseline GFR <60 mL . min-1 . 1.73 m-2 (RR, 0.68; 95% CI, 0.47, 1.00; p = 0.050), and baseline creatinine level >1.5 mg/dL (RR, 0.82; 95% CI, 0.58-1.15; p = 0.251; Table 3).

clause the extractor read what became the number

2 · Its place on the map

Where it lands on the map

Rows are treatments, columns are outcomes. The coloured squares are the cells this paper feeds, coloured by the vote it casts there. Click one to jump to what this paper adds to it.

supports the treatmentfavours the comparatorno clear differenceread, but no usable result
3 · What it changes

What it adds to each cell

For every cell the paper feeds: the belief in the claim with and without this paper, and this paper's estimate drawn against every other readable study in the cell. The ringed dot is this paper.

Statins×cardiovascular events

SupportsOpen on the map →What to test next →

30 readable studies in this cell: 18 favour the treatment, 11 find no difference, 1 favour the comparator.

Belief with this paper
0.86replicated · 12 families support, 2 contradict · against placebo
Without itNot a counted family in this claim, so removing it changes nothing.
← favours the treatmentfavours the comparator →
1 · no effect
HR 0.750.64 to 0.88
NCT023442907,769 enrolled · 2015
HR 0.640.48 to 0.84
HR 1.781.00 to 3.17
NCT03944512102 enrolled · 2019
RR 0.670.37 to 1.19

This paper's own estimate is on a different scale from the rest of the cell, so it is not drawn here.

Statins×all-cause mortality

No readable resultOpen on the map →What to test next →

14 readable studies in this cell: 4 favour the treatment, 9 find no difference, 1 favour the comparator.

Belief with this paper
0.50contested · 3 families support, 2 contradict · against placebo
Without itNot a counted family in this claim, so removing it changes nothing.
← favours the treatmentfavours the comparator →
1 · no effect
NCT023442907,769 enrolled · 2015
HR 0.880.70 to 1.12
HR 1.000.90 to 1.12
NCT03944512102 enrolled · 2019
RR 0.670.37 to 1.19
RR 0.990.89 to 1.11

This paper's own estimate is on a different scale from the rest of the cell, so it is not drawn here.

4 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

5 · Its place in the literature

Who cites it

15 citing papers in PubMed, 3 syntheses or guidelines pooled it, 37 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Pooled it
  4. Article
  5. Ten things to know about ten cardiovascular disease risk factors - 2022.American journal of preventive cardiology · 2022
    Review
  6. Article
  7. Pharmaceutical biology · 2021
    Article
  8. Article
  9. Ten things to know about ten cardiovascular disease risk factors.American journal of preventive cardiology · 2021
    Review
  10. Review
  11. Article
  12. Article
  13. Lipid lowering in renal disease.Australian prescriber · 2017
    Review
  14. Article
  15. Article
6 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

7 · Who and what money

Authors and funding

6 authors at 2 institutions in 1 country.

Xiao Zhang
Chun Xiang
Yu-Hao Zhou
An Jiang
Ying-Yi Qin
Jia HeDepartment of Health Statistics, Second Military Medical University, 200433 Shanghai, China. hejia63@yeah.net.
Second Military Medical University · CNSeventh People's Hospital of Shanghai · CN

Funding

No grant is acknowledged in the PubMed record.

8 · The paper itself

Abstract

The marked sentences are the ones the graph read a number from.

backgroundStatins are commonly used to lower total cholesterol levels in the general population to prevent cardiovascular events. However, the effects of statins in patients with chronic kidney disease remain unclear. We therefore performed a meta-analysis to assess the effects of statin therapy on cardiovascular outcomes in patients with mild to moderate chronic kidney disease.

methodsWe systematically searched PubMed, EmBase, the Cochrane Central Register of Controlled Trials, proceedings of major meetings, and reference lists of articles for relevant literature. Only randomized clinical trials were included. Outcomes analysed included cardiovascular disease, total mortality, myocardial infarction, stroke, cardiovascular death, and possible drug-related adverse events. Subgroup analyses were also performed based on the population characteristics and clinical indexes.

resultsTwelve trials met our inclusion criteria. Overall, statin therapy resulted in a 24% reduction in the risk of cardiovascular disease (RR = 0.76,95% confidence interval [CI], 0.72- 0.80), a 21% reduction in the risk of total mortality (RR = 0.79,95% CI, 0.72-0.86), a 34% reduction in the risk of myocardial infarction (RR = 0.66,95% CI, 0.52-0.83), a 30% reduction in the risk of stroke (RR = 0.70,95% CI, 0.57-0.85), and a 17% reduction in the risk of cardiovascular mortality (RR = 0.83,95% CI, 0.73- 0.93). No statistically significant drug-related adverse events were noted. Subgroup analysis indicated that some important factors such as baseline creatinine level ≥1.5 mg/dL, baseline glomerular filtration rate (GFR), and cardiovascular disease history could affect cardiovascular outcomes.

conclusionStatin therapy had a clear effect on cardiovascular disease, total mortality, stroke, and myocardial infarction in patients with mild to moderate renal disease. Subgroup analysis indicated that baseline GFR, baseline creatinine level, and a history of cardiovascular disease might play an important role in the cardiovascular outcomes.

Indexed as

BiomarkersCardiovascular DiseasesCreatinineDyslipidemiasGlomerular Filtration RateHumansHydroxymethylglutaryl-CoA Reductase InhibitorsKidneyOdds RatioRandomized Controlled Trials as TopicRenal Insufficiency, ChronicRisk AssessmentRisk FactorsSeverity of Illness IndexTreatment OutcomeBiomarkersCreatinineHydroxymethylglutaryl-CoA Reductase Inhibitors

Identifiers

PMID24529196
PMCPMC4015624
OpenAlexW2021311160

What Socratic holds

Textfull text, public
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.