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Are statins created equal? Evidence from randomized trials of pravastatin, simvastatin, and atorvastatin for cardiovascular disease prevention.
Am Heart J 2006; 151(2):273-81AH

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.

Authors+Show Affiliations

Department of Epidemiology and Biostatistics, McGill University, Montréal, Quebec, Canada.No affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Review

Language

eng

PubMed ID

16442888

Citation

Zhou, Zheng, et al. "Are Statins Created Equal? Evidence From Randomized Trials of Pravastatin, Simvastatin, and Atorvastatin for Cardiovascular Disease Prevention." American Heart Journal, vol. 151, no. 2, 2006, pp. 273-81.
Zhou Z, Rahme E, Pilote L. Are statins created equal? Evidence from randomized trials of pravastatin, simvastatin, and atorvastatin for cardiovascular disease prevention. Am Heart J. 2006;151(2):273-81.
Zhou, Z., Rahme, E., & Pilote, L. (2006). Are statins created equal? Evidence from randomized trials of pravastatin, simvastatin, and atorvastatin for cardiovascular disease prevention. American Heart Journal, 151(2), pp. 273-81.
Zhou Z, Rahme E, Pilote L. Are Statins Created Equal? Evidence From Randomized Trials of Pravastatin, Simvastatin, and Atorvastatin for Cardiovascular Disease Prevention. Am Heart J. 2006;151(2):273-81. PubMed PMID: 16442888.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Are statins created equal? Evidence from randomized trials of pravastatin, simvastatin, and atorvastatin for cardiovascular disease prevention. AU - Zhou,Zheng, AU - Rahme,Elham, AU - Pilote,Louise, PY - 2004/11/01/received PY - 2005/04/01/accepted PY - 2006/1/31/pubmed PY - 2006/2/14/medline PY - 2006/1/31/entrez SP - 273 EP - 81 JF - American heart journal JO - Am. Heart J. VL - 151 IS - 2 N2 - 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. SN - 1097-6744 UR - https://www.unboundmedicine.com/medline/citation/16442888/Are_statins_created_equal_Evidence_from_randomized_trials_of_pravastatin_simvastatin_and_atorvastatin_for_cardiovascular_disease_prevention_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-8703(05)00361-3 DB - PRIME DP - Unbound Medicine ER -