Srovnání hypolipidemické účinnosti statinů

Cor Vasa 2003, 44(1):27-32

Comparing the lipid-lowering efficacy of statins

Tomáš Janota^*, Richard Češka: III. interní klinika, Všeobecná fakultní nemocnice a 1. lékařská fakulta Univerzity Karlovy, Praha, Česká republika

To date, only several trials have been conducted comparing the lipid-lowering effects of several statins and their individual doses. We made an analysis of published lipid-lowering effects from different studies to obtain data based on a large number of examinations.
The analysis covered data from studies conducted in the 1990-1999 period, showing changes in lipidemia after different doses of statins. Not included were results of studies with dose adjustment depending on the effect so that higher-dose statins were not used only in poor responders. The results of over 23,000 examinations in 48 different trials were analyzed. The method of weighted means made it possible to process simultaneously the results of series of different sizes and to calculate the mean changes in lipid levels following different doses of individual statins.
As expected, and consistent with literary data, 5 mg atorvastatin was able to reduce LDL-cholesterol (LDL-C) about the same as 10 mg simvastatin, 20 mg lovastatin and pravastatin, and 40 mg fluvastatin (i. e., by 24-29%). The lipid-lowering action, as evaluated by the decrease in LDL-C and total cholesterol, showed a linear increase. When doubling statin dose, LDL-C and total cholesterol declined by another 6% and 5%. However, with atorvastatin, increasing the dose by more than 40 mg no longer brought an increase in the effect. Triglyceride levels being affected most significantly by atorvastatin. Statin action on triglyceride levels correlated closely with the effect on total cholesterol and LDL-C. A correlation with statin dose was evident. However, interpretation of results requires caution because of a number of factors such as different duration of reviewed studies or different baseline lipidemia levels which may affect the results.