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Adverse events associated with individual statin treatments for cardiovascular disease: an indirect comparison meta-analysis.
QJM 2012; 105(2):145-57QJM

Abstract

BACKGROUND

Statins are the most widely prescribed drug available. Due to this reason, it is important to understand the risks involved with the drug class and individual statins.

AIM

We conducted a meta-analysis and employed indirect comparisons to identify differing risk effects across statins.

DESIGN

We included any randomized clinical trial (RCT) of atorvastatin, fluvastatin, lovastatin, pitavastatin, pravastatin, rosuvastatin and simvastatin used for cardiovascular disease event prevention. The main outcome was adverse events [all-cause mortality, cancers, rhabdomylosis, diabetes, aspartate and alanine aminotransferase (AST/ALT), and creatinine kinase (CK) increases beyond the upper limit of normal]. In order to evaluate the relative effects of each drug on adverse events, we calculated adjusted indirect comparisons of the adverse-event outcomes.

RESULTS

Seventy-two trials involving 159,458 patients met our inclusion criteria. Overall, statin treatments significantly increased the rate of diabetes when compared to controls (OR: 1.09; 95% CI: 1.02-1.16) and elevated AST (OR: 1.31; 95% CI: 1.04-1.66) and ALT (OR: 1.28; 95% CI: 1.11-1.48) levels when compared to controls. Using indirect comparisons, we also found that atorvastatin significantly elevated AST levels compared to pravastatin (OR: 2.21; 95% CI: 1.13-4.29) and simvastatin significantly increased CK levels when compared to rosuvastatin (OR: 4.39; 95% CI: 1.01-19.07). Higher dose studies had increased risk of AST elevations.

DISCUSSION

Although statins are generally well tolerated, there are risks associated with almost all drugs. With few exceptions, statins appear to exert a similar risk across individual drugs.

Authors+Show Affiliations

Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Meta-Analysis

Language

eng

PubMed ID

21920996

Citation

Alberton, M, et al. "Adverse Events Associated With Individual Statin Treatments for Cardiovascular Disease: an Indirect Comparison Meta-analysis." QJM : Monthly Journal of the Association of Physicians, vol. 105, no. 2, 2012, pp. 145-57.
Alberton M, Wu P, Druyts E, et al. Adverse events associated with individual statin treatments for cardiovascular disease: an indirect comparison meta-analysis. QJM. 2012;105(2):145-57.
Alberton, M., Wu, P., Druyts, E., Briel, M., & Mills, E. J. (2012). Adverse events associated with individual statin treatments for cardiovascular disease: an indirect comparison meta-analysis. QJM : Monthly Journal of the Association of Physicians, 105(2), pp. 145-57. doi:10.1093/qjmed/hcr158.
Alberton M, et al. Adverse Events Associated With Individual Statin Treatments for Cardiovascular Disease: an Indirect Comparison Meta-analysis. QJM. 2012;105(2):145-57. PubMed PMID: 21920996.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Adverse events associated with individual statin treatments for cardiovascular disease: an indirect comparison meta-analysis. AU - Alberton,M, AU - Wu,P, AU - Druyts,E, AU - Briel,M, AU - Mills,E J, Y1 - 2011/09/14/ PY - 2011/9/17/entrez PY - 2011/9/17/pubmed PY - 2012/4/12/medline SP - 145 EP - 57 JF - QJM : monthly journal of the Association of Physicians JO - QJM VL - 105 IS - 2 N2 - BACKGROUND: Statins are the most widely prescribed drug available. Due to this reason, it is important to understand the risks involved with the drug class and individual statins. AIM: We conducted a meta-analysis and employed indirect comparisons to identify differing risk effects across statins. DESIGN: We included any randomized clinical trial (RCT) of atorvastatin, fluvastatin, lovastatin, pitavastatin, pravastatin, rosuvastatin and simvastatin used for cardiovascular disease event prevention. The main outcome was adverse events [all-cause mortality, cancers, rhabdomylosis, diabetes, aspartate and alanine aminotransferase (AST/ALT), and creatinine kinase (CK) increases beyond the upper limit of normal]. In order to evaluate the relative effects of each drug on adverse events, we calculated adjusted indirect comparisons of the adverse-event outcomes. RESULTS: Seventy-two trials involving 159,458 patients met our inclusion criteria. Overall, statin treatments significantly increased the rate of diabetes when compared to controls (OR: 1.09; 95% CI: 1.02-1.16) and elevated AST (OR: 1.31; 95% CI: 1.04-1.66) and ALT (OR: 1.28; 95% CI: 1.11-1.48) levels when compared to controls. Using indirect comparisons, we also found that atorvastatin significantly elevated AST levels compared to pravastatin (OR: 2.21; 95% CI: 1.13-4.29) and simvastatin significantly increased CK levels when compared to rosuvastatin (OR: 4.39; 95% CI: 1.01-19.07). Higher dose studies had increased risk of AST elevations. DISCUSSION: Although statins are generally well tolerated, there are risks associated with almost all drugs. With few exceptions, statins appear to exert a similar risk across individual drugs. SN - 1460-2393 UR - https://www.unboundmedicine.com/medline/citation/21920996/Adverse_events_associated_with_individual_statin_treatments_for_cardiovascular_disease:_an_indirect_comparison_meta_analysis_ L2 - https://academic.oup.com/qjmed/article-lookup/doi/10.1093/qjmed/hcr158 DB - PRIME DP - Unbound Medicine ER -