Comparative Lipid-Lowering/Increasing Efficacy of 7 Statins in Patients with Dyslipidemia, Cardiovascular Diseases, or Diabetes Mellitus: Systematic Review and Network Meta-Analyses of 50 Randomized Controlled Trials.

Xiaodan Zhang,Zhiyan Liu,Xiaona Jia,Xiaocong Pang,Xia Zhao,Lu Xing,Kun Hu,Lingyue Ma,Zhe Wang,Qian Xiang,Yimin Cui

doi:10.1155/2020/3987065

Abstract

Objective The drug efficacy may differ among different statins, and evidence from head-to-head comparisons is sparse and inconsistent. The study is aimed at comparing the lipid-lowering/increasing effects of 7 different statins in patients with dyslipidemia, cardiovascular diseases, or diabetes mellitus by conducting systematic review and network meta-analyses (NMA) of the lipid changes after certain statins' use. Methods In this study, we searched four electronic databases for randomized controlled trials (RCTs) published through February 25, 2020, comparing the lipid-lowering efficacy of no less than two of the included statins (or statin vs. placebo). Three reviewers independently extracted data in duplicate. Firstly, mixed treatment overall comparison analyses, in the form of frequentist NMAs, were conducted using STATA 15.0 software. Then, subgroup analyses were conducted according to different baseline diseases. At last, sensitivity analyses were conducted according to age and follow-up duration. The trial was registered with PROSPERO (number CRD42018108799). Results As a result, seven statin monotherapy treatments in 50 studies (51956 participants) were used for the analyses. The statins included simvastatin (SIM), fluvastatin (FLU), atorvastatin (ATO), rosuvastatin (ROS), lovastatin (LOV), pravastatin (PRA), and pitavastatin (PIT). In terms of LDL-C lowering, rosuvastatin ranked 1st with a surface under cumulated ranking (SUCRA) value of 93.1%. The comparative treatment efficacy for LDL-C lowering was ROS>ATO>PIT>SIM>PRA>FLU>LOV>PLA. All of the other ranking and NMA results were reported in SUCRA plots and league tables. Conclusions According to the NMAs, it can be concluded that rosuvastatin ranked 1st in LDL-C, ApoB-lowering efficacy and ApoA1-increasing efficacy. Lovastatin ranked 1st in TC- and TG-lowering efficacy, and fluvastatin ranked 1st in HDL-C-increasing efficacy. The results should be interpreted with caution due to some limitations in our review. However, they can provide references and evidence-based foundation for drug selection in both statin monotherapies and statin combination therapies.

Highlights

Coronary heart disease (CHD) is the leading cause of death in most countries, with a high prevalence currently driven by dual epidemics of obesity and diabetes [1]
The 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhAHDCDT_3987065/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol [3] recommends the use of statins based on risk factors for cardiovascular disease, rather than low-density lipoprotein (LDL) level targets that were formerly used to guide statin intensity according to the Third Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (ATP III) dyslipidemia guideline [4]
Articles published through February 25, 2020, were searched using the following keyword combination strategy: lovastatin (All Fields) OR pravastatin (All Fields) OR simvastatin (All Fields) OR fluvastatin (All Fields) OR atorvastatin (All Fields) OR rosuvastatin (All Fields) OR pitavastatin (All Fields) OR statins (All Fields) AND randomized controlled trial (All Fields)

Summary

Introduction

Coronary heart disease (CHD) is the leading cause of death in most countries, with a high prevalence currently driven by dual epidemics of obesity and diabetes [1]. Statins are the hypolipidemic treatment of choice for hyperlipidemia with a confirmed atherosclerotic cardiovascular disease (ASCVD) protective effect, proven even in normolipemic patients [2]. Dyslipidemia treatment is based on individualized risk factor assessment. The 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhAHDCDT_3987065/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol [3] recommends the use of statins based on risk factors for cardiovascular disease, rather than low-density lipoprotein (LDL) level targets that were formerly used to guide statin intensity according to the Third Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (ATP III) dyslipidemia guideline [4]

Methods

Results

Conclusion