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Secondary prevention of major cerebrovascular events with seven different statins: a multi-treatment meta-analysis

Authors Zhong P, Wu D, Ye X, Wu Y, Li T, Tong S, Liu X

Received 28 February 2017

Accepted for publication 4 July 2017

Published 30 August 2017 Volume 2017:11 Pages 2517—2526

DOI https://doi.org/10.2147/DDDT.S135785

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Akshita Wason

Peer reviewer comments 3

Editor who approved publication: Dr Tuo Deng

Ping Zhong,1,2,* Danhong Wu,3,* Xiaofei Ye,4 Ying Wu,2 Tuming Li,2 Shuwen Tong,2 Xueyuan Liu1,5

1Department of Neurology, Shanghai Tenth People’s Hospital, Nanjing Medical University, 2Department of Neurology, Shanghai Traditional Chinese and Western Medicine Hospital, Shanghai University of Traditional Chinese Medicine, 3Department of Neurology, Shanghai Fifth People’s Hospital, Fudan University, 4Department of Statistics, Second Military Medical University, 5Department of Neurology, Shanghai Tenth People’s Hospital, Tongji University, Shanghai, People’s Republic of China

*These authors contributed equally to this work

Background: Statins have been recommended for the use in atherosclerotic cardiovascular diseases, but different statins have distinct pharmacological characteristics. This multi-treatment meta-analysis aimed to evaluate the efficacy of seven statins in the secondary prevention of major cerebrovascular events (CVEs).
Methods and analyses: The PubMed, Embase, Cochrane Database of Systematic Reviews and Cochrane Central Register of Controlled Trials were searched to identify studies published between January 1, 2011, and June 30, 2016. The included randomized controlled trials investigated the efficacy of lovastatin, atorvastatin, fluvastatin, simvastatin, pitavastatin, pravastatin or rosuvastatin in the secondary prevention of CVEs. The primary outcomes were CVEs; the secondary outcomes were all-cause death, fatal stroke and nonfatal stroke. Meta-analysis and network meta-analysis were used for data synthesis.
Results: A total of 42 studies with 82,601 patients were included for analysis. In the secondary prevention of cardiovascular diseases, the major CVEs in pravastatin (risk ratio [RR] 0.87, 0.76–0.99)- and atorvastatin (RR 0.59, 0.49–0.72)-treated patients reduced significantly compared with controls. Indirect comparisons with network meta-analysis showed that RR was 0.60 (0.40–0.92) for atorvastatin compared with rosuvastatin. Compared to controls, the all-cause death was reduced by 12% in statins-treated patients (RR 0.88, 0.81–0.96). Indirect comparisons with network analysis showed a significant difference in the nonfatal stroke between fluvastatin-treated patients and lovastatin-treated patients (RR 0.28, 0.07–0.95).
Conclusion: Different statins have distinct pharmacological characteristics, and there are differences in statistical and clinical outcomes among several statins.

Keywords: atherosclerotic cardiovascular disease, cerebrovascular event, randomized, controlled trial, primary outcome

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