EFFICACY OF 3-HYDROXY-3-METHYLGLUTARYL COENZYME-A REDUCTASE INHIBITORS IN THE TREATMENT OF PATIENTS WITH HYPERCHOLESTEROLEMIA - A METAANALYSIS OF CLINICAL-TRIALS

Recent studies have documented the longterm impact of 3-hydroxy-3-meth ylglutaryl coenzyme A (HMG-CoA) reductase inhibitors on mortality and morbidity related to coronary heart disease, establishing the link bet ween lowering cholesterol levels and reducing cardiac events. Our stud y was a comparative Literature review and meta-analysis of the efficac y of four HMG-CoA reductase inhibitors-fluvastatin, lovastatin, pravas tatin, and simvastatin-used in the treatment of patients with hypercho lesterolemia. The data sources for our meta-analysis of the efficacy o f these cholesterol-lowering agents were 52 randomized, double-masked clinical trials with at least 25 patients per treatment arm. The resul ts showed all four agents to be effective in reducing blood cholestero l levels. We computed summary efficacy estimates for all published dos e strengths for the four agents. Fluvastatin 20 mg/d reduced low-densi ty lipoprotein cholesterol (LDL-C) levels by 21.0% and total cholester ol (total-C) levels by 16.4%; fluvastatin 40 mg/d reduced these levels by 23.1% and 17.7%, respectively. Lovastatin 20 mg/d reduced LDL-C le vels by 24.9% and total-C levels by 17.7%; lovastatin 80 mg/d reduced these levels by 39.8% and 29.2%, respectively. Pravastatin 10 mg/d red uced LDL-C levels by 19.3% and total-C levels by 14.0%; pravastatin 80 mg/d reduced these levels by 37.7% and 28.7%, respectively. Simvastat in 2.5 mg/d reduced LDL-C levels by 22.9% and total-C levels by 15.7%; simvastatin 40 mg/d reduced these levels by 40.7% and 29.7%, respecti vely. The results of our meta-analysis can be used in conjunction with treatment objectives and comparative cost-effectiveness data for thes e agents to decide appropriate therapeutic alternatives for individual patients.