비심혈관 질환 결과에 대한 스타틴 이득, Many effects of statins on non-cardiovascular disease (non-CVD) outcomes

No benefits of statins on noncardiovascular disease outcomes (November 2018)

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심혈관 질환을 감소시키는 데 여러 가지 임상 시험이 스타틴의 분명한 이점을 보여 주었지만 비심혈관 질환 (non-CVD)의 효과는 일관되게 입증되지 않았습니다. 이전의 증거와 일치하게, 275개 이상의 비심혈관 질환에 대한 스타틴 요법의 효과를 검사한 관찰 연구와 무작위 임상 시험의 메타 분석 pooled anlysis에서 대부분의 비심혈관 결과에 대한 스타틴 이점의 확신 증거를 발견하지 못했습니다.

https://annals.org/aim/article-abstract/2706169/statins-multiple-noncardiovascular-outcomes-umbrella-review-meta-analyses-observational-studies?doi=10.7326%2fM18-0808

Abstract

Background:

Many effects of statins on non–cardiovascular disease (non-CVD) outcomes have been reported.

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Purpose:

To evaluate the quantity, validity, and credibility of evidence regarding associations between statins and non-CVD outcomes and the effects of statins on these outcomes.

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Data Sources:

MEDLINE and EMBASE (English terms only, inception to 28 May 2018).

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Study Selection:

Meta-analyses (published in English) of observational studies and of randomized controlled trials (RCTs) that examined non-CVD outcomes of statin intake.

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Data Extraction:

Two investigators extracted data from meta-analyses and individual studies. Credibility assessments based on summary effect sizes from a random-effects model, between-study heterogeneity, 95% prediction interval, small-study effect, excess significance, and credibility ceilings were devised to classify evidence.

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Data Synthesis:

This review explored 278 unique non-CVD outcomes from 112 meta-analyses of observational studies and 144 meta-analyses of RCTs. For observational studies, no convincing (class I) evidence, 2 highly suggestive (class II) associations (decreased cancer mortality in patients with cancer and decreased exacerbation in patients with chronic obstructive pulmonary disease), 21 suggestive (class III) associations, and 42 weak (class IV) associations were identified. One outcome from the RCTs (decreased all-cause mortality in patients with chronic kidney disease) attained a sufficient amount of evidence with no hints of bias. For adverse events, observational studies showed suggestive evidence that statins increase the risk for diabetes and myopathy. Among the RCTs, no statistically significant effects were found on myopathy, myalgia, or rhabdomyolysis.

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Limitations:

Studies with relevant data and outcomes not included in the meta-analyses may have been missed. Credibility assessments relied on several assumptions and arbitrary thresholds.

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Conclusion:

The absence of convincing evidence of an association between statins and non-CVD outcomes supports leaving the current recommendations unchanged.

REF. UpToDate 2019.03.17