medwireNews: Moderate- or high-intensity rosuvastatin and high-intensity simvastatin and atorvastatin are the most effective statins for reducing non-high-density lipoprotein (HDL) cholesterol levels in people with diabetes, study findings indicate.
The network meta-analysis, published in The BMJ, showed that the reductions in non-HDL levels over 12 weeks were only “moderate” versus placebo.
Nonetheless, Alexander Hodkinson (University of Manchester, UK) and co-authors say: “Given the potential improvement in accuracy in predicting cardiovascular disease when non-HDL [cholesterol] is used as the primary target, our findings could inform policy on which statin types and intensities are most effective by reducing non-HDL [cholesterol] in patients with diabetes and at risk of cardiovascular disease.”
The analysis included data from 11,698 participants with type 1 or type 2 diabetes who received one of seven statins at various intensities in 36 randomized controlled trials.
The researchers report that, after a median 12 weeks of treatment, individuals given rosuvastatin at high intensity had the greatest reduction in non-HDL cholesterol levels versus placebo, with a mean difference of 2.31 mmol/L. Individuals who received moderate-intensity rosuvastatin or high-intensity simvastatin or atorvastatin had mean differences of 2.27 mmol/L, 2.26 mmol/L, and 2.20 mmol/L, respectively, versus placebo.
In an analysis that ranked each treatment by its ability to reduce non-HDL cholesterol levels, rosuvastatin at moderate intensity was top (surface under the cumulative ranking curve of 77.5%), followed by rosuvastatin at high intensity (76.8%), simvastatin at high intensity (76.7%) and atorvastatin at high intensity (76.3%).
The lowest ranked treatment, other than placebo, was low-intensity fluvastatin with a surface under the cumulative ranking curve score of 8.5%.
The investigators also found that the most effective treatments for low-density lipoprotein cholesterol were simvastatin and rosuvastatin, with mean differences of 1.93 mmol/L and 1.76 mmol/L, respectively, versus placebo.
For total cholesterol, high-intensity atorvastatin, rosuvastatin, and simvastatin were most effective relative to placebo, at mean differences of 2.21 mmol/L, 2.18 mmol/L, and 2.20 mmol/L, respectively.
In addition, the relative risk for nonfatal myocardial infarction was reduced by a significant 43% with atorvastatin at moderate intensity compared with placebo, but Hodkinson et al note that only four studies, all with atorvastatin, reported this endpoint.
There were no significant differences among the treatments for discontinuations, nonfatal stroke, or cardiovascular deaths.
Finally, a subgroup analysis among 4670 patients at greater risk for major cardiovascular events showed that atorvastatin at high intensity led to the biggest reduction in levels of non-HDL cholesterol versus placebo, with a mean difference of 1.98 mmol/L.
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