A Meta-Analysis of Randomized Controlled Trials Comparing the Efficacy and Safety of Hydrophilic Versus Lipophilic Statins in Acute Coronary Syndrome Patients

Statins differ in their solubility. Some previous studies suggested a difference in clinical efficacy and adverse events between hydrophilic and lipophilic statins. The purpose of this study is to compare the efficacy and safety of hydrophilic and lipophilic statins in patients with acute coronary s...

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Bibliographic Details
Published in:	Curēus (Palo Alto, CA) Vol. 16; no. 9; p. e68481
Main Authors:	Mohamad, Rofayda M, Almoayad, Safiah A, Alanmy, Aseel Ahmed A, Alzahrani, Mohammed Abdullah S, Alshahrani, Saeed Hassan S, Alharbi, Bandar Eid H, Hassan, Nahal Hassan A, Baqays, Mohammed Khalid A, Asiri, Shuruq Talea B, Meftah, Fatema Jasim M, Alharthi, Abdulrahman Ayed R, Ayoub, Saleha Mohammed H, Alharbi, Maali Hamdan S
Format:	Journal Article
Language:	English
Published:	United States Cureus Inc 02-09-2024 Cureus
Subjects:	Acute coronary syndromes Cardiology Cardiovascular disease Cholesterol Clinical trials Diabetes Emergency Medicine Enzymes Family/General Practice Heart attacks Hypertension Meta-analysis Search strategies Statins Italy South Korea United Kingdom > UK China Japan meta-analysis acute coronary syndrome lipophilic statins hydrophilic statins myocardial infarction
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Summary:	Statins differ in their solubility. Some previous studies suggested a difference in clinical efficacy and adverse events between hydrophilic and lipophilic statins. The purpose of this study is to compare the efficacy and safety of hydrophilic and lipophilic statins in patients with acute coronary syndrome. The databases of MEDLINE/PubMed, Cochrane Library, the Web of Science, and Scopus were systemically searched for articles published from inception until the 18th of July 2024. The primary outcome included major adverse cardiac events (MACE), while the secondary outcomes included myocardial infarction (MI), unstable angina (UA), revascularization, stroke, all-cause mortality, cardiovascular deaths, and adverse events. The results were pooled as risk ratio (RR) along with their 95% confidence intervals (CI). Nine studies were included. Hydrophilic statins showed a significantly higher risk of MACE and UA compared to lipophilic statins (RR 1.11 [95% CI 1.02, 1.21] and 1.30 [95% CI 1.04, 1.62]), but subgroup analysis showed a lack of significant difference between statins of similar intensity (1.01 [95% CI 0.86, 1.18] and 0.98 [0.67, 1.45], respectively). Both statins showed comparable results regarding the occurrence of MI (1.18 [95% CI 0.98, 1.40]), revascularization (1.09 [95% CI 0.99, 1.20]), stroke (1.16 [95% CI 0.80, 1.66]), all-cause mortality (1.13 [95% CI 0.92, 1.38]), cardiovascular deaths (1.14 [95% CI 0.76, 1.72]), adverse events leading to discontinuation (1.03 [95% CI 0.56, 1.90]), increased alanine aminotransferase (0.61 [95% CI 0.32, 1.16]), increased creatine kinase (0.90 [95% CI 0.30, 2.72]), and increased serum creatinine (1.03 [95% CI 0.49, 2.19]). The efficacy and safety of hydrophilic and lipophilic statins are comparable when the cholesterol-lowering intensity of statins is similar. This suggests that intensity, rather than the lipophilicity of the statin, plays a more important role in the secondary prevention of MACE and individual adverse events.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 ObjectType-Review-3 content type line 23
ISSN:	2168-8184 2168-8184
DOI:	10.7759/cureus.68481