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Published on 15 January 2008

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Atorvastatin shows advantage over simvastatin

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New statin users without cardiovascular disease who took atorvastatin calcium tablets had a significantly lower relative risk of experiencing any cardiovascular event, a heart attack or revascularisation compared to patients who took simvastatin, a study has found.

The observational study of a large US managed-care claims database has just been published online in Clinical Therapeutics.

Patients taking atorvastatin (Lipitor®) had a significant 12% lower relative risk of experiencing a cardiovascular event.

In a secondary analysis, patients taking atorvastatin had a significant 15% lower relative risk of experiencing a heart attack, and a significant 12% lower relative risk of revascularisation compared to patients taking simvastatin.

These differences were evident in patients taking doses of atorvastatin or simvastatin that would have been expected to deliver similar LDL reductions (atorvastatin 10mg or 20mg or simvastatin 20mg or 40mg).

There was no significant difference between the groups in stroke or mini-stroke.

As with all observational studies, the findings should be regarded as hypothesis-generating.

Dr JoAnne Foody, associate professor of medicine at Harvard Medical School and director of the Cardiovascular Wellness Center at Brigham and Women’s/Faulkner Hospitals, Boston, USA, said: “An important concern for clinicians, as well as for public health in general, is whether patients treated with different statins will experience different cardiovascular outcomes.

“This study suggests that there may be differences in cardiovascular outcomes between atorvastatin and simvastatin.

“Given the large number of patients receiving statin therapy, the availability of generic statins and the clinical and economic burden of cardiovascular events, the results of this observational study could have significant public health implications.”

Dr Michael Berelowitz, a senior vice-president at Lipitor’s manufacturer, Pfizer, commented: “There has been widespread encouragement by managed-care companies and governments for physicians to prescribe generic statins based on what is believed to be comparable LDL-lowering doses, assuming that this will result in similar cardiovascular benefits.

“This analysis calls into question those assumptions and those policies and reaffirms that treatment decisions need to be made by physicians based on a patient’s risk for developing cardiovascular disease.”

Clinical Therapeutics

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