Variability of low-density lipoprotein cholesterol response with different doses of atorvastatin, rosuvastatin, and simvastatin: results from VOYAGER

Eur Heart J Cardiovasc Pharmacother. 2016 Oct;2(4):212-7. doi: 10.1093/ehjcvp/pvw006. Epub 2016 Mar 29.


Aims: Patient response to statin treatment is individual and varied. As a consequence, when using a specific-dose approach, as recommended in the 2013 American College of Cardiology/American Heart Association guideline, there will be a range of reductions in the concentration of low-density lipoprotein cholesterol (LDL-C). The aim of this study was to use individual patient data from the VOYAGER meta-analysis to determine the extent of the variability in LDL-C reduction in response to treatment across the recommended doses of different statins.

Methods and results: The percentage change from baseline in LDL-C was calculated using individual subject data collected from 32 258 patients treated with atorvastatin 10-80 mg, rosuvastatin 5-40 mg, or simvastatin 10-80 mg. The percentage change in LDL-C for each patient was then used to generate waterfall plots that demonstrated the extent of the variability in response to treatment at all doses of the three statins. The standard deviation of LDL-C reduction for all statins and doses ranged from 12.8 to 17.9%. The percentage of patients experiencing a suboptimal response (<30% reduction in LDL-C) ranged from 5.3 to 53.3%.

Conclusion: These results indicate that there is considerable individual variation in the LDL-C reduction at all doses of simvastatin, atorvastatin, and rosuvastatin.

Keywords: Atorvastatin; Low-density lipoprotein cholesterol; Rosuvastatin; Simvastatin; Variability.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Adult
  • Aged
  • Anticholesteremic Agents / therapeutic use*
  • Atorvastatin / therapeutic use*
  • Cholesterol, LDL / blood*
  • Clinical Trials as Topic
  • Dose-Response Relationship, Drug
  • Female
  • Humans
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors / therapeutic use*
  • Hypercholesterolemia / blood
  • Hypercholesterolemia / drug therapy*
  • Lipoproteins, LDL / blood*
  • Male
  • Middle Aged
  • Rosuvastatin Calcium / therapeutic use*
  • Simvastatin / therapeutic use*
  • Treatment Outcome


  • Anticholesteremic Agents
  • Cholesterol, LDL
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors
  • Lipoproteins, LDL
  • Rosuvastatin Calcium
  • Atorvastatin
  • Simvastatin