DTB review: Which statin, what dose?

DTB review: Which statin, what dose?

The authors of this DTB (Drug Therapy Bulletin) review discuss the relative merits of different statins in addressing cardiovascular risk under the following headings:

• Overview of effectiveness of statins
• Different statins at standard doses
• High versus standard doses of statins
• Unwanted effects
• Contraindications and precautions
• What do national guidelines say?
• Who needs high-dose therapy?
• Cost-effectiveness
• Should patients be switched?

The authors reiterate the advice that generic simvastatin is currently the most cost-effective statin and should be regarded as the first-line option for most patients. They make the following suggestions for the other statins (directly from source):

• Pravastatin: For patients in whom drug interactions are a problem, the interactions may be less likely if pravastatin is used instead. However, the weaker lipid-lowering effects of pravastatin make it a less attractive first choice.
• Atorvastatin: should be reserved for second-line treatment or for patients intolerant to simvastatin. Many patients currently taking atorvastatin could be switched to simvastatin, to gain similar benefits at lower cost.
• Rosuvastatin/fluvastatin: There are very limited clinical trial data for fluvastatin or rosuvastatin; these are much more expensive than simvastatin, and we can see no reason for using them in routine management.

Drug Therap Bull May 2007 Vol. 45 (5)