Efficacy And Safety Evaluation Of Intensive Statin Therapy In Older Patients With Coronary Heart Disease: A Systematic Review And Meta-analysis

Objective: To investigate the efficacy and safety of intensive statin inpatients≥65years of age with coronary heart disease.Method: We searched electronic databases for randomized controlledtrials public published up to April12013, which evaluated the efficacy andsafety of intensive statin therapy in patients≥65years of age with coronaryheart disease. After study selection with enrolling criteria, study assessmentaccording to revised Jadad Scores and bias risk assessment and dataextraction conducted by two reviewers independently, meta-analysis andsystematic review were performed by RevMan5.1software.Result: A total of5RCTs (11,132patients) were included in thismeta-analysis. They all were high quality and low bias risk studies. Themeta-analysis results showed significant change of serum lipid levels frombaseline. Intensive statin therapy could get LDL-C level changes as much as-55.4%(-32.4%in control group, p <0.001).It also had efficient effect on TCand Tg reduction, except for HDL-C elevation. The results showed no advantages of intensive statin therapy on prevention of mortality (bothall-cause mortality and cardiac mortality)(RR=0.97，95%CI，0.87-1.09，p=0.65and RR=0.95,95%CI,0.80-1.13, p=0.57) and cardiac arrest(RR=1.09,95%CI,0.56-2.11, p=0.81). However, the results revealedsignificant effect of intensive statin therapy on prevention of non-fatalmyocardial infarction (MI)(RR=0.78,95%CI，0.65-0.94，p=0.008), stroke(RR=0.72,95%CI,0.56-0.94, p=0.02) and coronary revascularization(RR=0.69,95%CI,0.52-0.90, p=0.007). Compared with control group,intensive statin therapy was associated with small absolute increase in ratesof drug discontinuation due to adverse events (3.9%), and the results showedsmall incidence of side effects such as myopathy, rhadomyolysis andelevation of CK and liver enzymes (the absolute increases in rates was1.7%).Conclusion: The meta-analysis results of RCTs showed significanteffects of intensive statin therapy on serum lipid level reduction and onprevention of nonfatal MI, stroke and coronary revascularization with smallabsolute increase risk of side effects. Our analysis supports the use ofintensive statin therapy in patients≥65years of age with coronary heartdisease.