Statins for the Primary Prevention of Coronary Heart Disease.

Object. The purpose of this study was to fully assess the role of statins in the primary prevention of coronary heart disease (CHD). Methods. We searched six databases (PubMed, the Cochrane Library, Web of Science, China National Knowledge Infrastructure, Wanfang Database, and Chinese Scientific Journal Database) to identify relevant randomized controlled trials (RCTs) from inception to 31 October 2017. Two review authors independently assessed the methodological quality and analysed the data using Rev Man 5.3 software. Risk ratios and 95% confidence intervals (95% CI) were pooled using fixed/random-effects models. Funnel plots and Begg's test were conducted to assess publication bias. The quality of the evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Results. Sixteen RCTs with 69159 participants were included in this review. Statins can effectively decrease the occurrence of angina (RR=0.70, 95% CI: 0.58 similar to 0.85, I-2 =0%), nonfatal myocardial infarction (MI) (RR=0.60, 95% CI: 0.51 similar to 0.69, I-2 =14%), fatal MI (RR=0.49, 95% CI: 0.24 similar to 0.98, I-2 =0%), any MI (RR=0.53, 95% CI: 0.42 similar to 0.67, I-2 =0%), any coronary heart events (RR=0.73, 95% CI: 0.68 similar to 0.78, I-2=0%), coronary revascularization (RR=0.66, 95% CI: 0.55 similar to 0.78, I-2 = 0%), and any cardiovascular events (RR=0.77, 95% CI: 0.72 similar to 82, I-2 = 0%). However, based on the current evidence, there were no significant differences in CHD deaths (RR=0.82, 95% CI: 0.66 similar to 1.02, I-2=0%) and all-cause mortality (RR=0.88, 95% CI: 0.76 similar to 1.01, I-2 =58%) between the two groups. Additionally, statins were more likely to result in diabetes (RR=1.21, 95% CI: 1.05 similar to 1.39, I-2 =0%). There was no evidence of publication biases, and the quality of the evidence was considered moderate. Conclusion. Statins seemed to be beneficial for the primary prevention of CHDs but have no effect on CHD death and all-cause mortality.