A multicenter, double-blind, one-year study comparing safety and efficacy of atorvastatin versus simvastatin in patients witb hypercholesterolemia

Dart, Anthony M.; Jerums, George; Nicholson, Geoffrey C.; d’Emden, Michael C; Hamilton‐Craig, Ian; Tallis, George A.; Best, James D.; West, Michael R.; Sullivan, David; Bracs, P. U.; Black, Donald M.

doi:10.1016/s0002-9149(97)00280-4

Cited by 174 publications

(68 citation statements)

References 16 publications

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“…Furthermore, success rates differed among the statins, ranging from 24.8% for fluvastatin to 54.7% for atorvastatin. Several studies have revealed that atorvastatin was more effective in attaining the LDL-C target goal than four other statins (simvastatin, pravastatin, lovastatin, and fluvastatin) in patients with or without CAD (19)(20)(21)(22). Our results were compatible with previous findings in non-Japanese populations.…”

Section: Discussionsupporting

confidence: 91%

The Status of Lipid Management in 1,836 Patients with Coronary Artery Disease: A multicenter survey to evaluate the percentage of Japanese coronary artery disease patients achieving the target low-density lipoprotein cholesterol level specified by the Japan Atherosclerosis Society

Nagashima

Kasanuki

2005

JAT

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To determine the status of lipid management in patients with coronary artery disease (CAD) in Japan, we assessed CAD patients who had been receiving lipid-lowering therapy for six months in a cross-sectional survey conducted between June 2001 and December 2002. We defined the achievement rate as the percentage of patients who achieved the target LDL-C level (< 100 mg/dl) specified by the Japan Atherosclerosis Society (JAS). A total of 1,836 Japanese CAD patients were enrolled. In total, 549 (29.9%) achieved the target level. The achievement rate among those receiving statin therapy was 41.3%, which was significantly higher than that (23.4%) among the patients not receiving statin (P < 0.0001). The rate differed with the type of statin; being 54.7% for atorvastatin, 24.8% for pravastatin, 37.1% for simvastatin, and 27.8% for fluvastatin. A multiple regression analysis revealed that atorvastatin use (P < 0.001), and simvastatin use (P = 0.004) significantly contributed to the achievement of the target LDL-C level. In conclusion, large proportions of CAD patients are not achieving the JAS target and the success rates are not similar among different statin therapies, suggesting that cardiologists should consider a more aggressive lipid-lowering therapy with the appropriate choice of statins in Japanese CAD patients. J Atheroscler Thromb, 2005; 12: 338-342.

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Section: Discussionsupporting

confidence: 91%

The Status of Lipid Management in 1,836 Patients with Coronary Artery Disease: A multicenter survey to evaluate the percentage of Japanese coronary artery disease patients achieving the target low-density lipoprotein cholesterol level specified by the Japan Atherosclerosis Society

Nagashima

Kasanuki

2005

JAT

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“…The LDL-C and TG reductions by atorvastatin and simvastatin observed in the present analysis were typical of what has been reported by others. [20][21][22] Atorvastatin produced slightly greater reductions in LDL-C (Ϫ37 to Ϫ54% for atorvastatin vs. Ϫ35 to Ϫ49% for simvastatin) and TG (Ϫ22 to Ϫ31% for atorvastatin vs. Ϫ22 to Ϫ26% for simvastatin). However, the overall pattern of response (dose-dependent reductions) was the same for both drugs and was maintained across all of the subgroups examined.…”

Section: Discussionmentioning

confidence: 99%

Differential effects of simvastatin and atorvastatin on high‐density lipoprotein cholesterol and apolipoprotein A‐I are consistent across hypercholesterolemic patient subgroups

Davidson

Ose

Fröhlich

et al. 2003

Clinical Cardiology

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SummaryBackground: In addition to lowering plasma levels of lowdensity lipoprotein cholesterol (LDL-C), statins also raise high-density lipoprotein cholesterol (HDL-C).Hypothesis: Recent studies have shown that treatment with simvastatin results in larger increases in HDL-C than those seen with atorvastatin. The results of three clinical studies are analyzed, comparing the effects of simvastatin and atorvastatin on HDL-C and apolipoprotein A-I (apo A-I) in the total cohort and in several subgroups of hypercholesterolemic patients. The three studies were all multicenter, randomized clinical trials that included simvastatin (20-80 mg) and atorvastatin (10-80 mg) treatment arms. The subgroup analyses performed were gender; age (< 65 and ≥ 65 years); baseline HDL-C (male: <40 or ≥40 mg/dl; female: < 45 or ≥45 mg/dl), baseline LDL-C (< 160 or ≥ 160 mg/dl), and baseline triglycerides (< 200 or ≥ 200 mg/dl).Results: Both drugs produced similar increases in HDL-C levels at low doses; however, at higher drug doses (40 and 80 mg), HDL-C showed a significantly greater increase with simvastatin than with atorvastatin (p < 0.05 to < 0.001). Therefore, while HDL-C remained consistently elevated across all doses of simvastatin, there appeared to be a pattern of decreasing

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“…Tailoring the starting dose according to individual LDL-C reduction requirements may aid in the achievement of target LDL-C levels [12,15]. There is evidence to suggest that baseline LDL-C levels impact overall LDL-C reduction, [16][17][18] and that treatment with intensive lipid lowering therapy results in greater reductions in LDL-C and a higher proportion of subjects achieving targets compared with more moderate regimens [19][20][21][22][23][24][25][26][27][28][29]. Thus, selecting an initial starting dose calculated to achieve the required LDL-C reduction, may allow more patients to reach targets more quickly, reducing the need for dose increases, thus improving clinical outcomes and being more cost-effective in the long term [30,31].…”

Section: Introductionmentioning

confidence: 99%

Effect of individualizing starting doses of a statin according to baseline LDL-cholesterol levels on achieving cholesterol targets: The Achieve Cholesterol Targets Fast with Atorvastatin Stratified Titration (ACTFAST) study

et al. 2007

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Aims: To investigate whether selecting the starting dose of atorvastatin according to baseline and target (<2.6 mmol/L) LDL-cholesterol (LDL-C) values would allow high-risk subjects to achieve target LDL-C concentration within 12 weeks, with the initial dose or a single uptitration. Methods and results: Twelve-week, prospective, open-label trial that enrolled 2117 high-risk subjects (statin-free [SF] or statin-treated [ST]). Subjects with LDL-C >2.6 mmol/L (100 mg/dL) but ≤5.7 mmol/L (220 mg/dL) were assigned a starting dose of atorvastatin (10, 20, 40 or 80 mg/day) based on LDL-C and status of statin use at baseline, with a single uptitration at 6 weeks, if required. There was no washout for ST subjects. At study end, 80% of SF (82%, 82%, 83% and 72% with 10, 20, 40 and 80 mg, respectively) and 59% of ST (60%, 61% and 51% with 20, 40 and 80 mg, respectively) subjects reached LDL-C target. In the ST group, an additional 21-41% reduction in LDL-C was observed over the statin used at baseline. Atorvastatin was well tolerated. Conclusion: This study confirms that individualizing the starting dose of atorvastatin according to baseline and target LDL-C values (i.e. the required LDL-C reduction), allows a large majority of high-risk subjects to achieve target safely, within 12 weeks, with the initial dose or with a single titration.

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A multicenter, double-blind, one-year study comparing safety and efficacy of atorvastatin versus simvastatin in patients witb hypercholesterolemia

Cited by 174 publications

References 16 publications

The Status of Lipid Management in 1,836 Patients with Coronary Artery Disease: A multicenter survey to evaluate the percentage of Japanese coronary artery disease patients achieving the target low-density lipoprotein cholesterol level specified by the Japan Atherosclerosis Society

The Status of Lipid Management in 1,836 Patients with Coronary Artery Disease: A multicenter survey to evaluate the percentage of Japanese coronary artery disease patients achieving the target low-density lipoprotein cholesterol level specified by the Japan Atherosclerosis Society

Differential effects of simvastatin and atorvastatin on high‐density lipoprotein cholesterol and apolipoprotein A‐I are consistent across hypercholesterolemic patient subgroups

Effect of individualizing starting doses of a statin according to baseline LDL-cholesterol levels on achieving cholesterol targets: The Achieve Cholesterol Targets Fast with Atorvastatin Stratified Titration (ACTFAST) study

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