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Additionally, there were significant decreases seen in nonfatal myocardial infarction for atorvastatin at moderate intensity compared with placebo (relative risk, 0.57, 95 percent CI, 0.43−0.76 n=4 studies). In 4,670 patients at higher risk of a major cardiovascular event, high-intensity atorvastatin showed the biggest reduction in non-HDL-C levels ( −1.98, 95 percent CI, −4.16 to 0.26 surface under the cumulative ranking curve, 64 percent).įor the reduction in low-density lipoprotein cholesterol (LDL-C) levels, the most effective were high-intensity simvastatin ( −1.93, 95 percent CI, −2.63 to −1.21) and rosuvastatin (−1.76, 95 percent CI, −2.37 to −1.15). Likewise, atorvastatin and simvastatin at any intensity and pravastatin at low intensity effectively reduced levels of non-HDL-C. Levels of non-HDL-C decreased with rosuvastatin at high ( − 2.31 mmol/L, 95 percent CI, Of the participants, 11,698 were included in the meta-analysis. Evidence certainty was determined through the confidence in network meta-analysis framework.įorty-two trials including 20,193 adults met the eligibility criteria. They also conducted a subgroup analysis to compare patients at risk of major cardiovascular events with those at low or moderate risk. The researchers performed a Bayesian network meta-analysis to assess the treatment effect on non-HDL-C by mean differences and 95 percent credible intervals (CIs). The databases of Medline, Cochrane, and Embase were searched from inception to 1 December 2021 for randomized controlled trials comparing statins in adults with type 1 or 2 diabetes mellitus. “Given the potential improvement in accuracy in predicting cardiovascular disease (CVD) when non-HDL-C is used as the primary target, our findings could inform policy on which statin types and intensities are most effective by reducing non-HDL-C in patients with diabetes and at risk of CVD,” the researchers said.Ī systematic review and network meta-analysis was conducted to compare the efficacy of different statins by intensity on levels of non-HDL-C for the prevention of CVD in people with diabetes. Harrison's Principles of Internal Medicine.Treatment with rosuvastatin, given at moderate and high intensity doses, as well as simvastatin and atorvastatin, given at high intensity doses, modestly reduce levels of nonhigh-density lipoprotein cholesterol (non-HDL-C) inĭiabetic patients over 12 weeks compared with placebo, a study has shown. Kasper DL, Fauci AS, Hauser SL, Longo DL, Lameson JL, Loscalzo J. Journal of the American College of Cardiology. 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults.
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Stone NJ, Robinson JG, Lichtenstein AH et al. Statin Use for the Primary Prevention of Cardiovascular Disease in Adults: Preventive Medication. Statins and elevated liver tests: what's the fuss?. Effects of Statins on High-Density Lipoproteins: A Potential Contribution to Cardiovascular Benefit. Effect of food on the pharmacodynamics and pharmacokinetics of atorvastatin, an inhibitor of HMG-CoA reductase. Whitfield LR, Stern RH, Sedman AJ, Abel R, Gibson DM. We list the most important adverse effects. Interaction with certain drugs can increase the risk of myopathy (see “Interactions” section below). Treatment must be discontinued if myopathy / rhabdomyolysis occurs. Management: discontinue statin therapy for 2–4 weeks start treatment with a low-dose statin (e.g., pravastatin or fluvastatin ) once symptoms have resolved.May progress to rhabdomyolysis : rare but severe side-effect that may lead to myoglobulinuria → AKI ( ↑ BUN and ↑ creatinine ).Muscle pain and weakness, especially when used alongside fibrates or niacin.Myalgia : (muscle pain ): continue treatment as long as creatinine phosphokinase (CK) remain normal.Muscular : Statins decrease the synthesis of coenzyme Q 10 and impair energy production within the muscle.Hepatic : : (up to 3% of patients) ↑ LFTs due to the involvement of cytochrome P450 systems ( CYP3A4 and CYP2C9 ) in the breakdown of statins.General (common): headache and gastrointestinal symptoms (e.g., constipation, diarrhea, flatulence).