Statins in hypercholesterolaemia: A dose-specific meta-analysis of lipid changes in randomised, double blind trials

PubMed, the Cochrane Library, references lists of reports, and reviews were searched (September 2001) for randomised, double blind trials of statins for cholesterol in trials of 12 weeks or longer. Mean change in total cholesterol, LDL-cholesterol, HDL-cholesterol, and triglycerides was calculated using pooled data for particular statins, and for particular doses of a statin. Pre-planned sensitivity analyses were used to determine the effects of initial concentration of total cholesterol, study duration, the effects of major trials, and effects in placebo versus active controlled trials. Information was not collected on adverse events.Different statins at a range of doses reduced total cholesterol by 17–35% and LDL-cholesterol by 24–49% from baseline. Lower doses of statins generally produced less cholesterol lowering, though for most statins in trials of 12 weeks or longer there was at best only a weak relationship between dose and cholesterol reduction. Duration of treatment and baseline total cholesterol concentration did not alter the amount of the benefit attained.Statins are effective medicines and confer benefit to patients in terms of primary and secondary prevention of coronary heart disease. Reductions in total cholesterol of 25% or more and LDL cholesterol of more than 30% were recorded for fixed doses of simvastatin 40 mg, atorvastatin 10 mg, and rosuvastatin 5 mg and 10 mg.Cholesterol-lowering drug prescriptions have increased seven fold in the last five years in the UK, with statins now accounting for 92% of prescriptions and 95% of cost (about €350 million a year in 2001) [1]. Simvastatin (43%) and atorvastatin (32%) are the most commonly prescribed. Long-term benefits are reduced heart attacks and strokes [2-4]. Good evidence on primary and secondary prevention informs clinical decision-making, and improves patient care.Two large surveys, in Scotland in the 1990's and in England in 1998 [5,6] identified large numbers of people with total cholesterol