Are statins created equal? Evidence from randomized trials of pravastatin, simvastatin, and atorvastatin for cardiovascular disease prevention
- PMID: 16442888
- DOI: 10.1016/j.ahj.2005.04.003
Are statins created equal? Evidence from randomized trials of pravastatin, simvastatin, and atorvastatin for cardiovascular disease prevention
Abstract
Background: The relative efficacy of different statins for long-term cardiovascular prevention remains largely undetermined.
Methods: Using adjusted indirect comparison, we compared 3 statins (pravastatin, simvastatin, and atorvastatin) based on published randomized placebo-controlled trials for long-term cardiovascular prevention. A systematic literature search between 1980 and 2004 was conducted. Randomized placebo-controlled trials of the 3 statins, which studied cardiovascular diseases or death as the outcome, enrolled > or = 1000 participants, and had > or = 1-year follow-up, were included. Trials were grouped according to the statin under study. A pooled relative risk (RR) was derived from each set of trials using a random-effects model. Adjusted indirect comparisons using pooled RRs were made between statins with regard to prespecified clinical outcomes.
Results: Eight placebo-controlled trials met the inclusion criteria, including 4 pravastatin trials (n = 25,572), 2 simvastatin trials (n = 24,980), and 2 atorvastatin trials (n = 13,143). All trials had a similar degree of lipid reduction. Graphical and statistical assessments showed minimal heterogeneity in the trials' effect sizes. Adjusted indirect comparisons did not reveal a statistically significant difference between statins in reducing fatal coronary heart disease and nonfatal myocardial infarctions (simvastatin vs pravastatin: RR 0.93 [95% CI 0.84-1.03]; atorvastatin vs simvastatin: RR 0.84 [95% CI 0.66-1.08]; atorvastatin vs pravastatin: RR 0.79 [95% CI 0.61-1.02]). We were unable to detect differences either in outcomes for fatal and nonfatal strokes, all cardiovascular deaths, and all-cause mortality.
Conclusion: Evidence from published statin randomized placebo-controlled trials suggests that pravastatin, simvastatin, and atorvastatin, when used at their standard dosages, show no statistically significant difference in their effect on long-term cardiovascular prevention.
Comment in
-
Pravastatin, simvastatin, and atorvastatin appear equally effective for preventing cardiovascular events.Evid Based Cardiovasc Med. 2006 Jun;10(2):135-7. doi: 10.1016/j.ebcm.2006.04.048. Epub 2006 May 24. Evid Based Cardiovasc Med. 2006. PMID: 16753534 No abstract available.
Similar articles
-
Atorvastatin: gold standard for prophylaxis of myocardial ischemia and stroke - comparison of the clinical benefit of statins on the basis of randomized controlled endpoint studies.Eur J Med Res. 2004 Jan 26;9(1):1-17. Eur J Med Res. 2004. PMID: 14766335 Review.
-
Differences between statins on clinical endpoints: a population-based cohort study.Curr Med Res Opin. 2005 Sep;21(9):1461-8. doi: 10.1185/030079905X61866. Curr Med Res Opin. 2005. PMID: 16197665
-
Low-density lipoprotein cholesterol (LDL-C) levels and LDL-C goal attainment among elderly patients treated with rosuvastatin compared with other statins in routine clinical practice.Am J Geriatr Pharmacother. 2007 Sep;5(3):185-94. doi: 10.1016/j.amjopharm.2007.10.002. Am J Geriatr Pharmacother. 2007. PMID: 17996658
-
Similar effects of atorvastatin, simvastatin and pravastatin on thrombogenic and inflammatory parameters in patients with hypercholesterolemia.Thromb Haemost. 2001 Jan;85(1):47-51. Thromb Haemost. 2001. PMID: 11204586 Clinical Trial.
-
Early time to benefit with intensive statin treatment: could it be the pleiotropic effects?Am J Cardiol. 2005 Sep 5;96(5A):54F-60F. doi: 10.1016/j.amjcard.2005.06.027. Am J Cardiol. 2005. PMID: 16126024 Review.
Cited by
-
Primary Prevention of Cardiocerebrovascular Diseases and Related Deaths According to Statin Type.Int J Environ Res Public Health. 2020 Aug 30;17(17):6309. doi: 10.3390/ijerph17176309. Int J Environ Res Public Health. 2020. PMID: 32872631 Free PMC article.
-
The protective effect of HMG-CoA reductase inhibitors against monocrotaline-induced pulmonary hypertension in the rat might not be a class effect: comparison of pravastatin and atorvastatin.Naunyn Schmiedebergs Arch Pharmacol. 2006 Dec;374(3):195-206. doi: 10.1007/s00210-006-0112-z. Epub 2006 Nov 11. Naunyn Schmiedebergs Arch Pharmacol. 2006. PMID: 17102939
-
Explaining why increases in generic use outpace decreases in brand name medicine use in multisource markets and the role of regulation.PLoS One. 2024 May 2;19(5):e0301716. doi: 10.1371/journal.pone.0301716. eCollection 2024. PLoS One. 2024. PMID: 38696520 Free PMC article.
-
Comparative Effectiveness of Anti-Hyperlipidemic Drugs Monotherapy in Primary Prevention of Cardiovascular Disease.Int J Gen Med. 2024 Oct 26;17:4947-4958. doi: 10.2147/IJGM.S479120. eCollection 2024. Int J Gen Med. 2024. PMID: 39478851 Free PMC article.
-
Would a national pharmaceutical strategy be bad for the cardiovascular health of Canadians?Can J Cardiol. 2007 Jul;23(9):719-20. doi: 10.1016/s0828-282x(07)70816-4. Can J Cardiol. 2007. PMID: 17622394 Free PMC article. No abstract available.
Publication types
MeSH terms
Substances
LinkOut - more resources
Full Text Sources
Other Literature Sources
Medical
Miscellaneous