Real-World Evidence of Statin Effectiveness in Lipid Management: A Systematic Review
Keywords:
Cholesterol, Lipid-profile, intervention, Efficacy, AtherosclerosisAbstract
Introduction:
Globally, dyslipidemia stands as a critical, adjustable risk factor for myocardial infarction. Our systematic review and meta-analysis were undertaken to illuminate the safety and efficacy of lipid-lowering therapies, focusing on the comparative effectiveness of varying intensities of statin therapies.
Methods:
We performed an extensive search across MEDLINE, EMBASE, and Cochrane databases to find studies evaluating the protective impacts of lipid-lowering treatments, especially against Coronary Heart Disease (CHD). Initial screening by two independent reviewers sifted through titles and abstracts to select pertinent studies and remove irrelevant, duplicate, or review articles. Further, a detailed examination of these chosen articles helped in refining the selection by excluding non-relevant studies. The inclusion criteria were clinical trials conducted in the past decade, published in English, involving CHD patients, and examining lipid-lowering treatments. The primary outcomes reviewed included mortality rates or percentages.
Results:
We included seventy-five randomized controlled trials (RCTs) comparing different statins directly. While baseline characteristics were mostly consistent across the studies, exceptions were noted in studies related to rosuvastatin. Doses of atorvastatin 10 mg, fluvastatin 80 mg, lovastatin 40–80 mg, and simvastatin 20 mg were shown to reduce LDL-C by 30–40%, and doses of fluvastatin 40 mg, lovastatin 10–20 mg, pravastatin 20–40 mg, and simvastatin 10 mg achieved a 20–30% reduction. Rosuvastatin and atorvastatin, at daily doses of 20 mg or more, were the only statins capable of lowering LDL-C by over 40%. The meta-analysis revealed a statistically significant, yet clinically modest, difference (less than 7%) in cholesterol reduction among statins. Data were insufficient for comparing CHD prevention and safety outcomes across statins.
Conclusions: The effects on HDL elevation and triglyceride reduction appear consistent across different statins when adjusted for equivalent dosages. Presently, the available evidence does not adequately support a determination of the relative safety or the comparative effectiveness of various statins in preventing CHD.
