Comparisons of Effects of Statins (Atorvastatin, Fluvastatin, Lovastatin, Pravastatin, and Simvastatin) on Fasting and Postprandial Lipoproteins in Patients With Coronary Heart Disease Versus Control Subjects

Am J Cardiol. 2004 Jan 1;93(1):31-9. doi: 10.1016/j.amjcard.2003.09.008.

Abstract

The effects of atorvastatin at 20, 40, and 80 mg/day on plasma lipoprotein subspecies were examined in a randomized, placebo-controlled fashion over 36 weeks in 97 patients with coronary heart disease (CHD) with low-density lipoprotein (LDL) cholesterol levels of >130 mg/dl and compared directly with the effects of fluvastatin (n = 28), pravastatin (n = 22), lovastatin (n = 24), and simvastatin (n = 25). The effects of placebo and 40 mg/day of each statin were also examined in subjects with CHD with subjects in the fasting state and in the fed state 4 hours after a meal rich in saturated fat and cholesterol and compared with results in age- and gender-matched control subjects. At all doses tested in the fasting and fed states, atorvastatin was significantly (p <0.01) more effective in lowering LDL cholesterol and non-high-density lipoprotein (HDL) cholesterol than all other statins, and significantly (p <0.05) more effective than all statins, except for simvastatin, in lowering triglyceride and remnant lipoprotein (RLP) cholesterol. At 40 mg/day in the fasting state, atorvastatin was significantly (p <0.01) more effective than all statins, except for lovastatin and simvastatin, in lowering cholesterol levels in small LDL, and was significantly (p <0.05) more effective than all statins, except for simvastatin, in increasing cholesterol in large HDL and in lowering LDL particle numbers. Our data indicate that atorvastatin was the most effective statin tested in lowering cholesterol in LDL, non-HDL, and RLP in the fasting and fed states, and getting patients with CHD to established goals, with fluvastatin, pravastatin, lovastatin, and simvastatin having about 33%, 50%, 60%, and 85% of the efficacy of atorvastatin, respectively, at the same dose in the same patients.

Publication types

  • Clinical Trial
  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Anticholesteremic Agents / administration & dosage
  • Anticholesteremic Agents / pharmacology*
  • Anticholesteremic Agents / therapeutic use
  • Atorvastatin
  • Cholesterol / blood
  • Cholesterol, HDL / blood
  • Cholesterol, HDL / drug effects
  • Cholesterol, LDL / blood
  • Cholesterol, LDL / drug effects
  • Coronary Disease / blood
  • Coronary Disease / prevention & control*
  • Dose-Response Relationship, Drug
  • Fasting
  • Fatty Acids, Monounsaturated / administration & dosage
  • Fatty Acids, Monounsaturated / pharmacology
  • Fatty Acids, Monounsaturated / therapeutic use
  • Female
  • Fluvastatin
  • Heptanoic Acids / administration & dosage
  • Heptanoic Acids / pharmacology
  • Heptanoic Acids / therapeutic use
  • Humans
  • Indoles / administration & dosage
  • Indoles / pharmacology
  • Indoles / therapeutic use
  • Lipoproteins / blood
  • Lipoproteins / drug effects*
  • Lovastatin / administration & dosage
  • Lovastatin / pharmacology
  • Lovastatin / therapeutic use
  • Male
  • Middle Aged
  • Postprandial Period
  • Pravastatin / administration & dosage
  • Pravastatin / pharmacology
  • Pravastatin / therapeutic use
  • Pyrroles / administration & dosage
  • Pyrroles / pharmacology
  • Pyrroles / therapeutic use
  • Simvastatin / administration & dosage
  • Simvastatin / pharmacology
  • Simvastatin / therapeutic use
  • Triglycerides / blood

Substances

  • Anticholesteremic Agents
  • Cholesterol, HDL
  • Cholesterol, LDL
  • Fatty Acids, Monounsaturated
  • Heptanoic Acids
  • Indoles
  • Lipoproteins
  • Pyrroles
  • Triglycerides
  • remnant-like particle cholesterol
  • Fluvastatin
  • Cholesterol
  • Lovastatin
  • Atorvastatin
  • Simvastatin
  • Pravastatin