Abstract 17409: Effects of Statin Therapy by Sex in a Meta-Analysis of Individual Patient Data from 169 139 Patients in the Cholesterol Treatment Trialists' Collaboration Study
Background: Statins have been shown to reduce cardiovascular risk and mortality, but the extent of their efficacy in women has been controversial.
Objective: Using individual patient data, we aimed to assess statin efficacy overall and by sex.
Methods: We analysed data from 26 randomised controlled trials assessing the effects of either statin vs. control or high dose statin vs. low dose statin on a series of prespecified CVD outcomes. Effects of statins on mortality and cardiovascular endpoints were expressed as the hazard ratio (HR, 95% CI for overall population/99% CI for subgroups) associated with a 1.0 mmol/L reduction of blood LDL-cholesterol achieved at 1 year.
Results: Of 169 138 participants, 45 495 (27%) were female. Statin treatment significantly reduced the overall population risk for each CVD endpoint. Major coronary and major vascular events were significantly reduced overall and in both men and women, though the reductions with statin therapy were somewhat smaller in women (neither P for interaction reached the 1% level of significance). Death from CVD and all-cause mortality were significantly reduced overall and in men, but again the treatment-by-sex interaction tests were not significant at the 1% level. Numbers needed to treat to prevent a major vascular event for each 1.0 mmol/L LDL-cholesterol reduction with statin therapy for men and women, respectively, were 20 and 30 in secondary prevention, and 51 and 127 in primary prevention. There was no treatment effect on noncardiovascular death, cancer incidence or cancer death overall and in either sex.
Conclusions: Both men and women benefit from reductions in major coronary and vascular events with statin therapy. The numbers needed to treat are higher for primary prevention, especially in women. Although mortality reductions are not independently significant in women, the balance of evidence supports routine statin therapy for individuals at risk of either sex.
- © 2011 by American Heart Association, Inc.