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