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This meta-analysis reveals that lipophilic and hydrophilic statins are similar in preventing cardiovascular outcomes. Safety profile is also alike among the two types. Although not clinically significant, the study finds that liver enzymes are more commonly elevated with fat-soluble statins (like simvastatin/zocor or atorvastatin/lipitor) then water-soluble ones (pravastatin/pravachol or rosuvastatin/crestor). Solubility characteristics should not be considered in choosing the right statin for cardiovascular prevention.

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Dr. Tashko is a distinguished lipidologist based in Montgomery County, Maryland, renowned for expertise in cholesterol and triglyceride management. Specializing in conditions like hypercholesterolemia and hypertriglyceridemia, he employs cutting-edge lipid testing methods, such as NMR and lipoprotein little a analysis. Dr. Tashko is dedicated to preventing atherosclerosis and cardiovascular disease through personalized approaches. His arsenal includes medications like Repatha, Praluent, Leqvio, and Fenofibrate, chosen based on patients' unique profiles. With a strong commitment to patient care, Dr. Tashko's holistic strategies incorporate lifestyle adjustments and evidence-based treatments, making him a prominent figure in the field. His exceptional care and focus on lipid-related concerns continue to positively impact the health and well-being of his patients.

J Clinical Lipidology, Meta-Analysis, June 2017

Introduction

Some available experimental studies have reported that hydrophilic statins might have advantages compared with lipophilic statins in patients with coronary artery disease (CAD). Therefore, we performed a meta-analysis of randomized controlled trials (RCTs) investigating the potential differences of lipophilic and hydrophilic statins in patients with CAD.

Methods: We systematically searched selected electronic databases up to September 2016 to select RCTs, which compared clinical outcomes of hydrophilic vs lipophilic statins. Primary endpoints were cardiovascular (CV) events: major adverse cardiac events, myocardial infarction, cardiac revascularization, stroke, CV death, CV hospitalization, and all-cause mortality. Secondary endpoints were safety parameters: drug discontinuation, statin-associated muscle symptoms and alanine aminotransferase level increase.

Statins

Results

A total of 11,697 patients from 11 RCTs, randomly allocated to lipophilic (n = 5736) or hydrophilic statins (n = 5961), with a mean follow-up 14 months, were included in the meta-analysis.

In comparison with hydrophilic, the lipophilic statins showed similar risk reduction for major adverse cardiac events, myocardial infarction, CV death, and all-cause mortality, as well as cardiac revascularization, stroke, drug discontinuation, and statin-associated muscle symptoms.

CV hospitalization was lower (RR 0.789, p = .024) and alanine aminotransferase elevation was higher (2.689, p ≤ .001) in lipophilic (than in hydrophilic-treated patients).

Conclusions & Highlights

In conclusion, similarity between hydrophilic and lipophilic statins holds between various clinical CAD settings.

Lipophilic and hydrophilic statins have similar efficacy and safety in patients with coronary artery disease.

No difference was observed also between various clinical coronary artery disease settings.

Both types of statins inhibit Ras homolog gene family, member A (RhoA) and increased nitric oxide that protect the myocardium against ischemia.

Published

By

Gerti Tashko, MD
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