Comparative Efficacy and Safety Among High-intensity Statins. Systematic Review and Meta-Analysis

Overview

Journal J Comp Eff Res

Specialty Health Services

Date 2023 Feb 27

PMID 36847307

Authors

Myriam Jaam

Hend Nasser Al-Naimi

Moumena Mahmoud Haddad

Dina Abushanab

Daoud Al-Badriyeh

Affiliations

Soon will be listed here.

Abstract

To summarize the evidence in terms of efficacy and safety of head-to-head studies of high-intensity statins regardless of the underlying population. A systematic review and meta-analysis was conducted to summarize the effect sizes in randomized controlled trials and cohort studies that compared high-intensity statins. Based on 44 articles, similar effectiveness was observed across the statins in reducing LDL levels from baseline. All statins were observed to have similar adverse drug reactions (ADRs), although higher dosages were associated with more ADRs. Based on a pooled quantitative analysis of atorvastatin 80 mg versus rosuvastatin 40 mg, rosuvastatin was statistically more effective in reducing LDL. This review further confirms that high-intensity statins reduce LDL by ≥50%, favoring rosuvastatin over atorvastatin. Additional data are needed to confirm the clinical significance on cardiovascular outcomes using real-world studies.

Citing Articles

Rosuvastatin accelerates the healing process of partial-thickness burn wounds in rats by reducing TNF-α levels.

Marneri A, Mulita F, Leivaditis V, Kotoulas S, Gkoutziotis I, Kalliopi S Arch Med Sci Atheroscler Dis. 2025; 9:e226-e240.

PMID: 40007987 PMC: 11851311. DOI: 10.5114/amsad/196825.

The Pleiotropic Effects of Lipid-Modifying Interventions: Exploring Traditional and Emerging Hypolipidemic Therapies.

Kounatidis D, Tentolouris N, Vallianou N, Mourouzis I, Karampela I, Stratigou T Metabolites. 2024; 14(7).

PMID: 39057711 PMC: 11278853. DOI: 10.3390/metabo14070388.

Rosuvastatin-Based Lipid-Lowering Therapy for the Control of LDL Cholesterol in Patients at High Vascular Risk.

Mostaza J, Escobar C J Clin Med. 2024; 13(7).

PMID: 38610659 PMC: 11012264. DOI: 10.3390/jcm13071894.

Statins and new-onset diabetes in primary prevention setting: an updated meta-analysis stratified by baseline diabetes risk.

Masson W, Lobo M, Barbagelata L, Nogueira J Acta Diabetol. 2023; 61(3):351-360.

PMID: 37934231 DOI: 10.1007/s00592-023-02205-w.

References

McKenney J, Jones P, Adamczyk M, Cain V, Bryzinski B, Blasetto J . Comparison of the efficacy of rosuvastatin versus atorvastatin, simvastatin, and pravastatin in achieving lipid goals: results from the STELLAR trial. Curr Med Res Opin. 2003; 19(8):689-98. DOI: 10.1185/030079903125002405. View

Crowe M, Sheppard L, Campbell A . Comparison of the effects of using the Crowe Critical Appraisal Tool versus informal appraisal in assessing health research: a randomised trial. Int J Evid Based Healthc. 2011; 9(4):444-9. DOI: 10.1111/j.1744-1609.2011.00237.x. View

Choi J, Choi C, Choi B, Park Y, Kang D, Jang W . New onset diabetes mellitus and cardiovascular events in Korean patients with acute myocardial infarction receiving high-intensity statins. BMC Pharmacol Toxicol. 2021; 22(1):11. PMC: 7863364. DOI: 10.1186/s40360-021-00476-z. View

Stone N, Robinson J, Lichtenstein A, Merz C, Blum C, Eckel R . 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013; 63(25 Pt B):2889-934. DOI: 10.1016/j.jacc.2013.11.002. View

Kumar A, Shariff M, Doshi R . Impact of rosuvastatin versus atorvastatin on coronary atherosclerotic plaque volume - a systematic review and meta-analysis with trial sequential analysis of randomized control trials. Eur J Prev Cardiol. 2019; 27(19):2138-2141. DOI: 10.1177/2047487319868035. View

Schwartz G, Bolognese M, Tremblay B, Caplan R, Hutchinson H, Raza A . Efficacy and safety of rosuvastatin and atorvastatin in patients with hypercholesterolemia and a high risk of coronary heart disease: a randomized, controlled trial. Am Heart J. 2004; 148(1):e4. DOI: 10.1016/j.ahj.2004.01.020. View

Yetley E, DeMets D, Harlan Jr W . Surrogate disease markers as substitutes for chronic disease outcomes in studies of diet and chronic disease relations. Am J Clin Nutr. 2017; 106(5):1175-1189. PMC: 5657291. DOI: 10.3945/ajcn.117.164046. View

Hoogerbrugge N, Jansen H . Atorvastatin increases low-density lipoprotein size and enhances high-density lipoprotein cholesterol concentration in male, but not in female patients with familial hypercholesterolemia. Atherosclerosis. 1999; 146(1):167-74. DOI: 10.1016/s0021-9150(99)00125-2. View

Jones P, McKenney J, Karalis D, Downey J . Comparison of the efficacy and safety of atorvastatin initiated at different starting doses in patients with dyslipidemia. Am Heart J. 2005; 149(1):e1. DOI: 10.1016/j.ahj.2004.07.025. View

10.

Jones P, Davidson M, Stein E, Bays H, McKenney J, Miller E . Comparison of the efficacy and safety of rosuvastatin versus atorvastatin, simvastatin, and pravastatin across doses (STELLAR* Trial). Am J Cardiol. 2003; 92(2):152-60. DOI: 10.1016/s0002-9149(03)00530-7. View

11.

Khurana S, Gupta S, Bhalla H, Nandwani S, Gupta V . Comparison of anti-inflammatory effect of atorvastatin with rosuvastatin in patients of acute coronary syndrome. J Pharmacol Pharmacother. 2015; 6(3):130-5. PMC: 4544133. DOI: 10.4103/0976-500X.162011. View

12.

. Prevention of cardiovascular events and death with pravastatin in patients with coronary heart disease and a broad range of initial cholesterol levels. N Engl J Med. 1998; 339(19):1349-57. DOI: 10.1056/NEJM199811053391902. View

13.

Ballantyne C, Blazing M, Hunninghake D, Davidson M, Yuan Z, Delucca P . Effect on high-density lipoprotein cholesterol of maximum dose simvastatin and atorvastatin in patients with hypercholesterolemia: results of the Comparative HDL Efficacy and Safety Study (CHESS). Am Heart J. 2003; 146(5):862-9. DOI: 10.1016/S0002-8703(03)00440-X. View

14.

Fulcher J, OConnell R, Voysey M, Emberson J, Blackwell L, Mihaylova B . Efficacy and safety of LDL-lowering therapy among men and women: meta-analysis of individual data from 174,000 participants in 27 randomised trials. Lancet. 2015; 385(9976):1397-405. DOI: 10.1016/S0140-6736(14)61368-4. View

15.

Stein E, Strutt K, Southworth H, Diggle P, Miller E . Comparison of rosuvastatin versus atorvastatin in patients with heterozygous familial hypercholesterolemia. Am J Cardiol. 2003; 92(11):1287-93. DOI: 10.1016/j.amjcard.2003.08.009. View

16.

Abushanab D, Al-Badriyeh D, Marquina C, Bailey C, Jaam M, Liew D . A Systematic Review of Cost-Effectiveness of Non-Statin Lipid-Lowering Drugs for Primary and Secondary Prevention of Cardiovascular Disease in Patients with Type 2 Diabetes Mellitus. Curr Probl Cardiol. 2022; 48(8):101211. DOI: 10.1016/j.cpcardiol.2022.101211. View

17.

Meek C, Reston J, Ramsbottom T, Pathmanathan H, Viljoen A . Use of high-intensity statin therapy with simvastatin 80 mg and atorvastatin 80 mg in primary care. Int J Clin Pract. 2011; 65(2):120-6. DOI: 10.1111/j.1742-1241.2010.02570.x. View

18.

Nicholls S, Ballantyne C, Barter P, Chapman M, Erbel R, Libby P . Effect of two intensive statin regimens on progression of coronary disease. N Engl J Med. 2011; 365(22):2078-87. DOI: 10.1056/NEJMoa1110874. View

19.

Crowe M, Sheppard L, Campbell A . Reliability analysis for a proposed critical appraisal tool demonstrated value for diverse research designs. J Clin Epidemiol. 2011; 65(4):375-83. DOI: 10.1016/j.jclinepi.2011.08.006. View

20.

Hong Y, Jeong M, Hachinohe D, Ahmed K, Choi Y, Cho S . Comparison of effects of rosuvastatin and atorvastatin on plaque regression in Korean patients with untreated intermediate coronary stenosis. Circ J. 2010; 75(2):398-406. DOI: 10.1253/circj.cj-10-0658. View