CTT 2010

More intensive statin regimens produced a 15% (95% CI 11-18; p<0·0001) further reduction in major vascular events compared with less intensive regimens; combining both trial types, major vascular events were reduced by RR 0·78 (95% CI 0·76-0·80; p<0·0001) per 1·0 mmol/L LDL cholesterol reduction.

Weighted mean further reduction in LDL cholesterol at 1 year was 0·51 mmol/L in the more vs less intensive trials; effects expressed per 1·0 mmol/L LDL cholesterol reduction

All-cause mortality reduced by 10% per 1·0 mmol/L LDL reduction (RR 0·90, 95% CI 0·87-0·93; p<0·0001), largely due to reductions in coronary heart disease deaths (RR 0·80, 99% CI 0·74-0·87; p<0·0001) and other cardiac deaths (RR 0·89, 99% CI 0·81-0·98; p=0·002); no significant effect on stroke deaths or other vascular deaths.

No significant effects were observed on deaths due to cancer or other non-vascular causes (RR 0·97, 95% CI 0·92-1·03; p=0·3) or on cancer incidence (RR 1·00, 95% CI 0·96-1·04; p=0·9), even at low LDL cholesterol concentrations.

“Compared with less intensive regimens, more intensive regimens produced a highly significant 15% (95% CI 11-18; p<0·0001) further reduction in major vascular events, consisting of separately significant reductions in coronary death or non-fatal myocardial infarction of 13% (95% CI 7-19; p<0·0001), in coronary revascularisation of 19% (95% CI 15-24; p<0·0001), and in ischaemic stroke of 16% (95% CI 5-26; p=0·005). Per 1·0 mmol/L reduction in LDL cholesterol, these further reductions in risk were similar to the proportional reductions in the trials of statin versus control. When both types of trial were combined, similar proportional reductions in major vascular events per 1·0 mmol/L LDL cholesterol reduction were found in all types of patient studied (rate ratio [RR] 0·78, 95% CI 0·76-0·80; p<0·0001), including those with LDL cholesterol lower than 2 mmol/L on the less intensive or control regimen. Across all 26 trials, all-cause mortality was reduced by 10% per 1·0 mmol/L LDL reduction (RR 0·90, 95% CI 0·87-0·93; p<0·0001), largely reflecting significant reductions in deaths due to coronary heart disease (RR 0·80, 99% CI 0·74-0·87; p<0·0001) and other cardiac causes (RR 0·89, 99% CI 0·81-0·98; p=0·002), with no significant effect on deaths due to stroke (RR 0·96, 95% CI 0·84-1·09; p=0·5) or other vascular causes (RR 0·98, 99% CI 0·81-1·18; p=0·8).”

Quoted from the abstract of Lancet 2010, checked word for word against PubMed. PubMed 21067804 · Full paper (DOI)

• CTT 2012 low risk (2012)Even in people at low baseline cardiovascular risk, lowering LDL cholesterol with statin therapy reduces major vascular events and all-cause mortality without increasing cancer risk, suggesting current risk-threshold guidelines for statin use may need reconsideration.
• CTT 2019 older people (2019)Statins reduce major vascular events across all age groups including older people, though the evidence for benefit beyond age 75 without pre-existing vascular disease is less direct and being addressed by further trials.
• PCSK9/ezetimibe diabetes meta-analysis (2020)Neither PCSK9 inhibitors nor ezetimibe increase the risk of new-onset diabetes when added to guideline-directed medical therapy.
• CTT 2022 muscle (2022)Statins cause a small, mostly mild excess of muscle pain primarily in the first year of treatment, with over 90% of muscle symptom reports in statin users not actually due to the statin, and this risk is far outweighed by cardiovascular benefits.