Article

The extent to which individual statins vary in terms of clinical
outcomes across all populations, in addition to secondary and primary prevention
has not been studied extensively in meta-analyses. METHODS:
We systematically
studied 199,721 participants in 92 placebo-controlled and active-comparator
trials comparing atorvastatin, fluvastatin, lovastatin, pravastatin,
rosuvastatin, and simvastatin in participants with, or at risk of developing,
cardiovascular disease. We performed pairwise and network meta-analyses for major
coronary events and all-cause mortality outcomes, taking into account the dose
differences across trials. Systematic review registration: PROSPERO
2011:CRD42011001470. RESULTS: There were only a few trials that evaluated
fluvastatin. Most frequent comparisons occurred between pravastatin and placebo,
atorvastatin and placebo, and rosuvastatin and atorvastatin. No trial directly
compared all six statins to each other. Across all populations, statins were
significantly more effective than control in reducing all-cause mortality (OR
0.87, 95% credible interval 0.82-0.92) and major coronary events (OR 0.69, 95% CI
0.64-0.75). In terms of reducing major coronary events, atorvastatin (OR 0.66,
95% CI 0.48-0.94) and fluvastatin (OR 0.59, 95% CI 0.36-0.95) were significantly
more effective than rosuvastatin at comparable doses. In participants with
cardiovascular disease, statins significantly reduced deaths (OR 0.82, 95% CI
0.75-0.90) and major coronary events (OR 0.69, 95% CI 0.62-0.77). Atorvastatin
was significantly more effective than pravastatin (OR 0.65, 95% CI 0.43-0.99) and
simvastatin (OR 0.68, 95% CI 0.38-0.98) for secondary prevention of major
coronary events. In primary prevention, statins significantly reduced deaths (OR
0.91, 95% CI 0.83-0.99) and major coronary events (OR 0.69, 95% CI 0.61-0.79)
with no differences among individual statins. Across all populations,
atorvastatin (80%), fluvastatin (79%), and simvastatin (62%) had the highest
overall probability of being the best treatment in terms of both outcomes. Higher
doses of atorvastatin and fluvastatin had the highest number of significant
differences in preventing major coronary events compared with other statins. No
significant heterogeneity or inconsistency was detected. CONCLUSIONS: Statins
significantly reduce the incidence of all-cause mortality and major coronary
events as compared to control in both secondary and primary prevention. This
analysis provides evidence for potential differences between individual statins,
which are not fully explained by their low-density lipoprotein
cholesterol-reducing effects. The observed differences between statins should be
investigated in future prospective studies.

Langue : ANGLAIS