A Cochrane review included 18 studies (19 trial arms) with a total of 56 934 subjects to assess the effects, both harms and benefits, of statins in people with no history of cardiovascular disease (CVD; study populations where 10% or less had a history of CVD). Fourteen studies recruited patients with specific conditions (raised lipids, diabetes, hypertension, microalbuminuria). The mean age of the participants was 57 years (range 28–97 years), and 60.3% were male. The studies observed outcomes ranging from 1 to 5.3 years.
All-cause mortality was reduced by statins (RR 0.86, 95% CI 0.79 to 0.94; 13 studies, n=48 060) as was combined fatal and non-fatal CVD endpoints (RR 0.75, 95% CI 0.70 to 0.81; 9 studies, n=23 805), combined fatal and non-fatal coronary heart disease (CHD) events (RR 0.73, 95% CI 0.67 to 0.80; 14 studies, n=48 049) and combined fatal and non-fatal stroke (RR 0.78, 95% CI 0.68 to 0.89; 10 studies, n=40 295). Benefits were also seen in the reduction of revascularisation rates (RR 0.62, 95% CI 0.54 to 0.72; 7 studies, n=42 403). Total cholesterol and LDL cholesterol were reduced in all trials but there was evidence of heterogeneity of effects. No excess of combined adverse events, cancers, myopathy, rhabdomyolysis, haemorrhagic stroke, liver enzyme elevation, renal dysfunction and arthritis were found, although not all trials reported fully on adverse events. An increased risk of incident diabetes was found in the 2 studies reporting this outcome. Patient perceived quality of life was reported in only one trial, which showed limited benefit.