Clinical Question:
Are statins (pravastatin, simvastatin, and atorvastatin) created equal for
cardiovascular prevention?
Bottom Line:
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.
Reference:
Am Heart J. 2006 Feb;151(2):273-81. Are statins created equal? Evidence from
randomized trials of pravastatin, simvastatin, and atorvastatin for
cardiovascular disease prevention. Zhou Z, Rahme E, Pilote L.
Study Design:
Randomized placebo-controlled trials
Synopsis:
The relative efficacy of different statins for long-term cardiovascular
prevention remains largely undetermined. 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. 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. |