Evidence map›Statins × all-cause mortality›PMID 19567909›Full record

SynthesisBMJ (Clinical research ed.)2009

The benefits of statins in people without established cardiovascular disease but with cardiovascular risk factors: meta-analysis of randomised controlled trials.

J J Brugts, T Yetgin, S E Hoeks, A M Gotto, J Shepherd, R G J Westendorp, A J M de Craen, R H Knopp, H Nakamura, P Ridker and 2 more

Registry-linked trialAbstract readMeta-AnalysisReview
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in BMJ (Clinical research ed.), 2009. The graph read 1 number from its abstract, feeding 1 cell of the map, but none could be read as for or against, so it casts no vote. It is linked to trial NCT03007524 (A Randomized Comparison of Low-dose Versus High-dose Rosuvastatin on Optical Coherence Tomography Based Early Vascular Healing for Patients With Acute Coronary Syndrome), which is not on this map. Cited by 273 papers, 18 of them syntheses that pooled it.

1number the graph read from it
0cells of the map it votes in
273citing papers in PubMed, 18 pooled it
–field-weighted citation impact
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.

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

All-cause mortalitycomparator not stated · ascvdfeeds one cell of the map
OR 0.880.81 to 0.96
Treatment with statins significantly reduced the risk of all cause mortality (odds ratio 0.88, 95% confidence interval 0.81 to 0.96), major coronary events (0.70, 0.61 to 0.81), and major cerebrovascular events (0.81, 0.71 to 0.93).
FeedsStatins×all-cause mortality

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×all-cause mortality

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

13 readable studies in this cell: 3 favour the treatment, 8 find no difference, 2 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
Effect of rosuvastatin in patients with chronic heart failure (the GIS…PMID 18757089 · 6,975 enrolled · 2002
HR 1.010.91 to 1.11
NCT03944512102 enrolled · 2019
RR 0.670.37 to 1.19
[Clinical study of the month. The ALLHAT-LLT trial].PMID 12647600 · 2003
RR 0.990.89 to 1.11
Rosuvastatin and cardiovascular events in patients undergoing hemodial…PMID 19332456 · 2009
HR 0.960.86 to 1.07
Rosuvastatin for primary prevention in older persons with elevated C-r…PMID 20404379 · 2010
HR 0.800.62 to 1.04
The Anglo-Scandinavian Cardiac Outcomes Trial: 11-year mortality follo…PMID 21873710 · 2011
HR 0.860.76 to 0.98
Rosuvastatin to prevent vascular events in men and women with elevated…PMID 18997196 · 2008
HR 0.800.67 to 0.97
Long-term follow-up of moderately hypercholesterolemic hypertensive pa…PMID 23889716 · 2013
HR 0.960.89 to 1.03
Pravastatin and cardiovascular outcomes stratified by baseline eGFR in…PMID 23816477 · 2013
HR 1.010.91 to 1.13
Association Between Use of Statins and Mortality in Patients With Hear…PMID 26243795 · 2015
HR 0.800.72 to 0.89

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.

NCT03007524 phase4unknown statusstarted 2016, after this paper: background citation

A Randomized Comparison of Low-dose Versus High-dose Rosuvastatin on Optical Coherence Tomography Based Early Vascular Healing for Patients With Acute Coronary Syndrome

Ran2016Enrolled80Registered outcomes25Posted comparisons0ConditionsAcute Coronary SyndromeArmsHigh dose Rosuvastatin, Low dose Rosuvastatin
PMID 23470492PMID 16054715PMID 18191683PMID 20176986PMID 11489933PMID 19926041PMID 20102942PMID 20554431PMID 20643240PMID 20731529PMID 21067804PMID 22607822other papers from this trial
Open the trial in the graph
5 · Its place in the literature

Who cites it

273 citing papers in PubMed, 18 syntheses or guidelines pooled it.

  1. Preoperative statin therapy for adults undergoing cardiac surgery.The Cochrane database of systematic reviews · 2024
    Pooled it
  2. Guideline
  3. Pooled it
  4. Guideline
  5. Pooled it
  6. Pooled it
  7. Pooled it
  8. Guideline
  9. Statins in Healthy Adults: A Meta-Analysis.Medicina (Kaunas, Lithuania) · 2021
    Pooled it
  10. Guideline
  11. Guideline
  12. Guideline
  13. Pooled it
  14. Pooled it
  15. Pooled it
  16. Guideline
  17. Potential increased risk of cancer from commonly used medications: an umbrella review of meta-analyses.Annals of oncology : official journal of the European Society for Medical Oncology · 2014
    Pooled it
  18. Statins for the primary prevention of cardiovascular disease.The Cochrane database of systematic reviews · 2013 · on this map
    Pooled it
  19. Trial
  20. Trial

213 more citing papers are in PubMed but not listed here.

6 · The record

Corrections and comments

7 · Who and what money

Authors and funding

12 authors.

J J BrugtsDepartment of Cardiology, Erasmus MC Thoraxcenter, 3015 GD, Rotterdam, Netherlands. j.brugts@erasmusmc.nl
T Yetgin
S E Hoeks
A M Gotto
J Shepherd
R G J Westendorp
A J M de Craen
R H Knopp
H Nakamura
P Ridker
R van Domburg
J W Deckers

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.

objectivesTo investigate whether statins reduce all cause mortality and major coronary and cerebrovascular events in people without established cardiovascular disease but with cardiovascular risk factors, and whether these effects are similar in men and women, in young and older (>65 years) people, and in people with diabetes mellitus.

designMeta-analysis of randomised trials. DATA SOURCES: Cochrane controlled trials register, Embase, and Medline. Data abstraction Two independent investigators identified studies on the clinical effects of statins compared with a placebo or control group and with follow-up of at least one year, at least 80% or more participants without established cardiovascular disease, and outcome data on mortality and major cardiovascular disease events. Heterogeneity was assessed using the Q and I(2) statistics. Publication bias was assessed by visual examination of funnel plots and the Egger regression test.

results10 trials enrolled a total of 70 388 people, of whom 23 681 (34%) were women and 16 078 (23%) had diabetes mellitus. Mean follow-up was 4.1 years. Treatment with statins significantly reduced the risk of all cause mortality (odds ratio 0.88, 95% confidence interval 0.81 to 0.96), major coronary events (0.70, 0.61 to 0.81), and major cerebrovascular events (0.81, 0.71 to 0.93). No evidence of an increased risk of cancer was observed. There was no significant heterogeneity of the treatment effect in clinical subgroups.

conclusionIn patients without established cardiovascular disease but with cardiovascular risk factors, statin use was associated with significantly improved survival and large reductions in the risk of major cardiovascular events.

Indexed as

AgedAge DistributionCardiovascular DiseasesCause of DeathFemaleHumansHydroxymethylglutaryl-CoA Reductase InhibitorsMaleMiddle AgedOdds RatioRandomized Controlled Trials as TopicRisk FactorsSex DistributionTreatment OutcomeHydroxymethylglutaryl-CoA Reductase Inhibitors

Identifiers

PMID19567909
PMCPMC2714690

What OpenQuestion holds

Texttitle and abstract
Read underepoch 390

Registered trials

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 OpenQuestion graph.