Statins equivalent for CVD prevention

Clinical Question:

Are there any differences in outcomes among the major statins?

Bottom Line:

The overall effectiveness of statin therapy on the most important outcomes — decreasing mortality, heart attacks, and strokes — is not different among the 3 major statins. These are the results from a meta-analysis; no study has directly compared equivalent doses of 2 statins. (LOE = 1a)


Zhou Z, Rahme E, Pilote L. Are statins created equal? Evidence from randomized trials of pravastatin, simvastatin, and atorvastatin for cardiovascular disease prevention. Am Heart J 2006;151:273-81.

Study Design:

Meta-analysis (randomized controlled trials)


Self-funded or unfunded


Outpatient (any)


The researchers conducted this analysis of the research on the benefit of statins in the prevention of cardiovascular disease (CVD). The statins under consideration were pravastatin (Pravachol), simvastatin (Zocor), and atorvastatin (Lipitor). They authors identified, through a search of MEDLINE and the Cochrane Controlled Trials Register databases, all randomized controlled trials of at least 1000 participants that evaluated CVD or mortality as an outcome over the course of at least 1 year. The used only English language studies. They took other short cuts in the systematic review process that likely had little effect on their conclusions; they did not perform duplicate searching or data abstraction. They identified 8 studies enrolling almost 64,000 people that compared 1 of the statins with either placebo or usual care. The authors did not include the single study that directly compared 2 statins since the marketing-friendly goal of that study was to compare the intensity of treatment rather than the relative effectiveness of the 2 drugs. All studies showed a similar degree of reduction in lipid levels. There was no difference among the statins in reducing fatal coronary heart disease, nonfatal myocardial infarctions, fatal and nonfatal strokes, all cardiovascular deaths, or mortality due to any cause.

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