Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from 170,000 participants in 26 randomised trials.

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).

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Taking all 26 trials together, there was a proportional reduction in all-cause mortality of 10% (95% CI 7–13; p<0·0001; figure 5 ) per 1·0 mmol/L reduction in LDL cholesterol, which consisted of a highly significant reduction in vascular mortality of 14% (95% CI 10–18; p<0·0001) and a marginally significant reduction in mortality from unknown causes of 13% (95% CI 1–24; p=0·04), with no apparent effect on non-vascular mortality (RR 0·97, 95% CI 0·92–1·03; p=0·3).

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