Clinical Question: Are there any differences in outcomes among the major statins?

Setting: Outpatient (any)

Study Design: Meta-analysis (randomized controlled trials)

Synopsis: The researchers conducted an analysis of the benefit of the statins pravastatin (Pravachol), simvastatin (Zocor), and atorvastatin (Lipitor) in the prevention of cardiovascular disease (CVD). They identified, through a search of MEDLINE and the Cochrane Registry, all randomized controlled trials with at least 1,000 participants that evaluated CVD or mortality as an outcome over at least one year. They used only English language studies. They did not perform duplicate searching or data abstraction, but that likely had little effect on their conclusions.

They identified eight studies enrolling almost 64,000 patients that compared one of the statins with placebo or usual care. The authors did not include the single study that directly compared two statins because the goal of that study was to compare the intensity of treatment rather than the relative effectiveness of the two drugs.

All studies showed a similar degree of reduction in lipid levels. There was no difference among the statins in reducing fatal coronary heart disease, nonfatal myocardial infarctions, fatal and nonfatal strokes, all cardiovascular deaths, or mortality from any cause.

Bottom Line: The overall effectiveness of statin therapy on the most important outcomes (i.e., decreasing mortality, heart attacks, and strokes) is not different among the three major statins. These are the results from a meta-analysis; no study has directly compared equivalent doses of two statins. (Level of Evidence: 1a)