Abstract
Cardiovascular disease is the leading cause of death and disability in Europe. Several large, population-based trials and their meta-analyses have shown the beneficial effects of statins in reducing mortality and cardiovascular morbidity both primary and secondary prevention. Use of generic drugs, which are bioequivalent to brand-name drugs, can help contain prescription drug spending. However, there is concern among patients and physicians that brandname drugs may be clinically superior to generic drugs. The aim of our study was to review the efficacy of generic statin therapy in both primary and secondary vascular prevention. Treatment with generic statins seem to be safe and quite effective. Lipid parameters should be monitorized, there are class effects in the lipid lowering potency of different drugs. Based on comparism trials, worsening lipid profile was associated with unfavourable outcome. From an economic point of view, society could gain a lot from substituting statin therapy, especially from therapeutic substitution. Moreover, prescribing generic or preferred medications within a therapeutic class seemed to be associated with improvements in adherence to therapy.
Highlights
Cardiovascular disease is the leading cause of death and disability in Europe [1]
Overall statin therapy significantly reduces relative risk of coronary events (RR, 0.73, 95% Confidence Interval (CI), 0.68, 0.77, *p < 0.0001), relative risk of cardiovascular disease mortality (RR, 0.78, 95% confidence intervals for ∆% (95% CI), 0.73, 0.84, *p < 0.0001), relative risk of non-fatal stroke (RR, 0.74, 95% CI, 0.67, 0.82, *p < 0.0001), relative risk of total stroke (RR, 0.77, 95% CI, 0.70, 0.84, *p < 0.001) and relative risk of all-cause death (RR, 0.85, 95% CI, 0.81, 0.89, *p < 0.0001)
The results showed that raising the dose of simvastatin or atorvastatin to 80 mg confers no mortality advantage, an increase in adverse reactions and only a slight decrease in myocardial infarctions and stroke versus a lower dose (Table 2)
Summary
Population-based trials and their metaanalyses have shown the beneficial effects of statins in reducing mortality and cardiovascular morbidity both primary and secondary prevention [1,2]. The problem of rising prescription drug costs has emerged as a critical policy issue, straining the budgets of patients and public/ private insurers and directly contributing to adverse health outcomes by reducing adherence to important medications [4,5,6,7,8]. Some physicians and patients have expressed concern that bioequivalent generic and brandname drugs may not be equivalent in their effects on various clinical parameters, including physiological measures such as heart rate or blood pressure, important laboratory measurements, and outcomes such as health system utilization or mortality [8]
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