— Results from a meta-analysis of 27 randomized trials Statins are not usually recommended for people at low risk of vascular disease, but the CTT Collaborative Group published an article in the medical journal The Lancet stating that for every 1 mmol/L reduction in low-density lipoprotein cholesterol (LDL-C) achieved by statin application in people with a 5-year risk of vascular disease of <10%, 11 out of every 1,000 people for a 5-year period would be spared from developing vascular disease. This meta-analysis included 27 (174,149 subjects) randomized controlled studies of LDL-C lowering by statins, 22 (134,537 subjects) of which were statin versus placebo controlled, and 5 studies (39,612 subjects) of which were intensive statin therapy versus low-dose statin. The meta-analysis looked at major vascular adverse events, including major coronary artery (coronary) events (nonfatal infarction or death due to coronary artery disease), stroke, and coronary revascularization. Subjects were categorized into 5 groups (<5%,≥5% to <10%, ≥10% to <20%, ≥20% to <30%, ≥30%) based on their 5-year risk of vascular disease in the control group, including the low-dose statin group. The reduction in vascular disease after a 1-mmol/L reduction in LDL-C in subjects was analyzed. Results showed that mean vascular risk was <10% in 5 of 27 studies, all of which were primary prevention studies. Most of the patients in the studies with mean vascular risk ≥20% had a history of vascular disease or were dialysis patients. Statin use resulted in significant reductions in 5-year vascular disease at low (<10%) and higher (≥10%) risk of vascular disease.For each 1-mmol/L reduction in LDL-C, the risk of vascular disease in the 5 groups of subjects was reduced by 38%, 31%, 21%, 19%, and 21%, respectively. This demonstrates that statins reduce the risk of vascular disease in populations with a lower risk of vascular disease. In these 27 studies, statins were associated with a 21% reduction in adverse vascular events for every 1 mmol/L reduction in LDL-C (P<0.001), with a 12% reduction in deaths due to vascular disease. Statin application reduced major coronary events by 43% and 39% and coronary revascularization by 48% and 37% in the two groups at low risk, with no difference in the trend toward lower coronary events and coronary revascularization compared with subjects at higher vascular risk. Stroke risk was reduced by 24% in both groups at low vascular risk. In the two groups at low vascular risk, there was still a greater reduction in the risk of vascular disease when subjects with prior vascular disease were excluded (39% and 34% of low-risk patients in the two groups, respectively). And the study suggests that statins did not increase the incidence of cancer or death in cancer patients. Gao Lijian, Department of Cardiovascular Medicine, Fu Wai Hospital, Beijing, China Previous studies have confirmed that in subjects without a history of vascular disease, the application of statins to lower LDL-C can reduce the risk of vascular disease by 20%. However, the role of statins in primary prevention is not well understood. There is a need to evaluate the vascular disease risk benefit in subjects in primary prevention, who have a lower risk of vascular morbidity. The present study suggests that statins lower LDL-C, resulting in a significant benefit to those at low risk of vascular risk, which may lead to changes in lipid-lowering guidelines.