In patients with stable coronary heart disease, only simvastatin and pravastatin showed a benefit of statin therapy with regard to a life-prolonging effect. No such evidence of a benefit was shown for atorvastatin, fluvastatin, and lovastatin. Studies on patient-relevant benefits of statins in patients with acute coronary syndrome were available for atorvastatin, pravastatin, and simvastatin.
Flaws in study design and study reporting make interpretation of data difficult with regard to comparative evaluations. The superiority of a specific statin over another with regard to patient-relevant endpoints was not demonstrated. In patients with diabetes mellitus, only simvastatin showed a benefit of statin therapy with regard to a life-prolonging effect. No such evidence of a benefit was shown for atorvastatin, fluvastatin, lovastatin, and pravastatin.
In studies conducted with the highest approved dose, discontinuations of therapy due to adverse events occurred more frequently in patients treated with atorvastatin than in patients treated with simvastatin.
In addition, liver enzyme elevations occurred more frequently with atorvastatin than with simvastatin or pravastatin.
It cannot be inferred from the available long-term intervention studies on different statins that the degree of LDL cholesterol lowering is appropriate to generally demonstrate or quantify benefits with regard to patient-relevant endpoints.