Evidence map›Paper›PMID 30287603›Full record

SynthesisBMJ open2018

Legacy effects of statins on cardiovascular and all-cause mortality: a meta-analysis.

Agnish Nayak, Andrew Hayen, Lin Zhu, Kevin McGeechan, Paul Glasziou, Les Irwig, Jenny Doust, Gabriel Gregory, Katy Bell

Open access · goldAbstract readMeta-Analysis
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in BMJ open, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
19citing papers in PubMed, 2 pooled it
9.7field-weighted citation impact, top 1% 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.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · 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.

3 · Its place in the literature

Who cites it

19 citing papers in PubMed, 2 syntheses or guidelines pooled it, 57 citations in OpenAlex.

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4 · The record

Corrections and comments

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

5 · Who and what money

Authors and funding

9 authors at 4 institutions in 1 country.

Agnish NayakUNSW Medicine, University of New South Wales, Sydney, New South Wales, Australia.
Andrew HayenAustralian Centre for Public and Population Health Research, University of Technology Sydney, Sydney, New South Wales, Australia.
Lin ZhuAustralian Centre for Public and Population Health Research, University of Technology Sydney, Sydney, New South Wales, Australia.
Kevin McGeechanUniversity of Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.
Paul GlasziouCentre for Research in Evidence Based Practice, Bond University, Gold Coast, Queensland, Australia.
Les IrwigUniversity of Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.
Jenny DoustCentre for Research in Evidence Based Practice, Bond University, Gold Coast, Queensland, Australia.
Gabriel GregoryThe University of Sydney School of Medicine, The University of Sydney, Sydney, New South Wales, Australia.
Katy BellUniversity of Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.ORCID 0000-0002-0137-3218
The University of Sydney · AUBond University · AUUniversity of Technology Sydney · AUUNSW Sydney · AU

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectivesTo assess evidence for 'legacy' (post-trial) effects on cardiovascular disease (CVD) mortality and all-cause mortality among adult participants of placebo-controlled randomised controlled trials (RCTs) of statins.

designMeta-analysis of aggregate data. SETTING/

participantsPlacebo-controlled statin RCTS for primary and secondary CVD prevention.

methodsData sources: PubMed, Embase from inception and forward citations of Cholesterol Treatment Trialists' Collaborators RCTs to 16 June 2016. STUDY SELECTION: Two independent reviewers identified all statin RCT follow-up reports including ≥1000 participants, and cardiovascular and all-cause mortality. DATA EXTRACTION AND SYNTHESIS: Two independent reviewers extracted data in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. MAIN OUTCOMES: Post-trial CVD and all-cause mortality.

resultsWe included eight trials, with mean post-trial follow-up ranging from 1.6 to 15.1 years, and including 13 781 post-trial deaths (6685 CVD). Direct effects of statins within trials were greater than legacy effects post-trials. The pooled data from all eight studies showed no evidence overall of legacy effects on CVD mortality, but some evidence of legacy effects on all-cause mortality (p=0.01). Exploratory subgroup analysis found possible differences in legacy effect for primary prevention trials compared with secondary prevention trials for both CVD mortality (p=0.15) and all-cause mortality (p=0.02). Pooled post-trial HR for the three primary prevention studies demonstrated possible post-trial legacy effects on CVD mortality (HR=0.87; 95% CI 0.79 to 0.95) and on all-cause mortality (HR=0.90; 95% CI 0.85 to 0.96).

conclusionsPossible post-trial statin legacy effects on all-cause mortality appear to be driven by the primary prevention studies. Although these relative benefits were smaller than those observed within the trial, the absolute benefits may be similar for the two time periods. Analysis of individual patient data from follow-up studies after placebo-controlled statin RCTs in lower-risk populations may provide more definitive evidence on whether early treatment of subclinical atherosclerosis is likely to be beneficial.

Indexed as

Cardiovascular DiseasesHydroxymethylglutaryl-CoA Reductase InhibitorsHumansMortalityRandomized Controlled Trials as TopicHydroxymethylglutaryl-CoA Reductase Inhibitorscholesterolearly diagnosisfollow-up studieshydroxymethylglutaryl-coa reductase inhibitorsmeta-analysisrandomised controlled trial

Identifiers

PMID30287603
PMCPMC6173243
OpenAlexW2895001427

What Socratic holds

Texttitle and abstract
LicenceCC BY-NC
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.