Curriculum in CardiologyAre statins created equal? Evidence from randomized trials of pravastatin, simvastatin, and atorvastatin for cardiovascular disease prevention
Section snippets
Study selection
We identified RCTs of pravastatin, simvastatin, and atorvastatin through a systematic literature search in the MEDLINE and the Cochrane Controlled Trials Register databases (Update Software Ltd, Oxford, UK, 2004) between 1980 and 2004 for English-language studies using the keywords atorvastatin, simvastatin, and pravastatin in combination with any of the following words: cholesterol, prevention, cardiovascular disease, myocardial infarction, coronary heart disease, ischemic heart disease, stroke
Results
The search resulted in 745 studies. Trials were excluded because they were ongoing trials (n = 56) or did not study CVD or death as the outcome (n = 678), or had <1 year follow-up (n = 1, MIRACL43). No trial that studied clinical outcomes (CVD or death) was excluded because of having <1000 subjects. Eight placebo-controlled RCTs met the inclusion criteria. These included 4 pravastatin trials (WOSCOPS1, CARE2, LIPID3, PROSPER5; total n = 25 572), 2 simvastatin trials (4S7, HPS8; total n = 24 980),
Discussion
Using the method of adjusted indirect comparison, we compared 3 major statins based on published large placebo-controlled RCTs. Our results revealed no statistically significant difference in the 3 statins used at their standard dosages for long-term cardiovascular prevention. Although there appears a trend that atorvastatin and simvastatin have a greater reduction in the major cardiac events.
The benefit of statins as a group is unquestionable, yet comparative data regarding the relative
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Dr Zhou was supported by a research scholarship from the Natural Science and Engineering Research Council of Canada (NSERC) and a fellowship from the Canadian Cardiovascular Outcome Research Team (CCORT). Dr Rahme is a research scholar funded by the Arthritis Society. Dr Pilote is a research scholar of the Canadian Institute for Health Research (CIHR) and a William Dawson Professor at McGill University. None of the authors has financial interest or conflict with regard to the content discussed in this manuscript.