Efficacy of 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors in the treatment of patients with hypercholesterolemia: a meta-analysis of clinical trials

• Published in: Clinical therapeutics Vol. 19; no. 4; pp. 778 - 797
• Main Authors: Kong, Sheldon Xiaodong, Crawford, Stephanie Y., Gandhi, Sanjay K., Seeger, John D., Schumock, Glen T., Lam, Nancy P., Stubbings, JoAnn, Dekker Schoen, Marieke
• Format: Journal Article
• Language: English
• Published: Belle Mead, NJ EM Inc USA 01.07.1997; Excerpta Medica
• Subjects: Anticholesteremic Agents - administration & dosage; Anticholesteremic Agents - therapeutic use; Biological and medical sciences; cholesterol; Clinical Trials as Topic; Fatty Acids, Monounsaturated - administration & dosage; Fatty Acids, Monounsaturated - therapeutic use; fluvastatin; General and cellular metabolism. Vitamins; HMG-CoA reductase inhibitors; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors - administration & dosage; Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use; hypercholesterolemia; Hypercholesterolemia - drug therapy; Indoles - administration & dosage; Indoles - therapeutic use; lovastatin; Lovastatin - administration & dosage; Lovastatin - therapeutic use; Medical sciences; Pharmacology. Drug treatments; pravastatin; Pravastatin - administration & dosage; Pravastatin - therapeutic use; Randomized Controlled Trials as Topic; simvastatin; Simvastatin - administration & dosage; Simvastatin - therapeutic use; HMG-CoA reductase inhibitors; fluvastatin; pravastatin; simvastatin; cholesterol; lovastatin; hypercholesterolemia; Human; Enzyme; Enzyme inhibitor; Cardiovascular disease; Metabolic diseases; Lipids; Hyperlipoproteinemia; Coronary heart disease; Metaanalysis; Chemotherapy; Hypercholesterolemia; Treatment; Hydroxymethylglutaryl-CoA reductase; Oxidoreductases; Dyslipemia; Antilipemic agent
• ISSN: 0149-2918; 1879-114X
• DOI: 10.1016/S0149-2918(97)80102-6

Recent studies have documented the long-term impact of 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors on mortality and morbidity related to coronary heart disease, establishing the link between lowering cholesterol levels and reducing cardiac events. Our study was a comparative literature review and meta-analysis of the efficacy of four HMG-CoA reductase inhibitors—fluvastatin, lovastatin, pravastatin, and simvastatin—used in the treatment of patients with hypercholesterolemia. The data sources for our meta-analysis of the efficacy of these cholesterol-lowering agents were 52 randomized, double-masked clinical trials with at least 25 patients per treatment arm. The results showed all four agents to be effective in reducing blood cholesterol levels. We computed summary efficacy estimates for all published dose strengths for the four agents. Fluvastatin 20 mg/d reduced low-density lipoprotein cholesterol (LDL-C) levels by 21.0% and total cholesterol (total-C) levels by 16.4%; fluvastatin 40 mg/d reduced these levels by 23.1% and 17.7%, respectively. Lovastatin 20 mg/d reduced LDL-C levels by 24.9% and total-C levels by 17.7%; lovastatin 80 mg/d reduced these levels by 39.8% and 29.2%, respectively. Pravastatin 10 mg/d reduced LDL-C levels by 19.3% and total-C levels by 14.0%; pravastatin 80 mg/d reduced these levels by 37.7% and 28.7%, respectively. Simvastatin 2.5 mg/d reduced LDL-C levels by 22.9% and total-C levels by 15.7%; simvastatin 40 mg/d reduced these levels by 40.7% and 29.7%, respectively. The results of our meta-analysis can be used in conjunction with treatment objectives and comparative cost-effectiveness data for these agents to decide appropriate therapeutic alternatives for individual patients.