Objectives: This study was a literature review assessing the clinical efficacy of statins available in Thailand (i.e., atorvastatin, fluvastatin, pravastatin, rosuvastatin and simvastatin) for use in reducing acute coronary syndrome (ACS) and stroke events.
Methods: A systematic review and a meta-analysis of randomized controlled trials (RCTs) of statins were studied. The clinical trials on an electronic Medline database were searched. Efficacy studies of statin monotherapy were compared with placebo or other statins on the occurrence of fatal and non-fatal ACS and stroke. Odds ratios (OR) and 95 percent confidence interval (CI) were used to determine the summary efficacy of statins. Indirect comparison of the random effect meta-analysis, using the Bayesian approach and WinBUGS14 software program, were applied.
Result: Twenty-nine RCTs in 26 studies enabled comparing statins with a placebo; one study compared statins with no treatment, another compared statins with usual care, and yet another compared atorvastatin with pravastatin. For ACS events, the relative risk reduction (RRR) of simvastatin was 42 percent (OR=0.58, 95%CI=0.51-0.65), the RRR of atorvastatin was 41 percent (OR=0.59, 95%CI=0.51-0.70) and the RRR of pravastatin was 26 percent (OR=0.74, 95%CI=0.66-0.83). For stroke events, the RRR of simvastatin was 26 percent (OR=0.74, 95%CI=0.66-0.83), the RRR of atorvastatin was 19 percent (OR=0.81, 95%CI=0.72-0.93) and the RRR of pravastatin was 14 percent (OR=0.86, 95%CI=0.75-0.97). However, fluvastatin did not significantly reduce ACS (OR=0.37, 95%CI=0.11-1.05) and stroke events (OR=0.85,
95%CI=0.46-1.55). No efficacy study of rosuvastatin on decreasing ACS and stroke events is yet available. Conclusion: The available evidence indicate that simvastatin, atorvastatin and pravastatin significantly reduced ACS and stroke events.