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Simvastatin ‘better tolerated’ than other statins, finds review

Simvastatin and pravastatin have better side-effect profiles compared with other more potent statins, claims a gold-standard meta-analysis.

The study

The authors conducted the largest ever analysis of randomised controlled trials published from 1 January 1985 to 10 March 2013 evaluating patients with and without cardiovascular disease and their statin use. They analysed 135 RCT of which 55 RCTs were two-armed placebo-controlled and 80 RCTs were two- or multi-armed active-comparator trials; in total including 246,955 individuals. The average trial follow up was 68 weeks (1.3 years).

The findings

Discontinuation due to adverse events in patients taking statins was not significantly different than those taking placebo, with an odds ratio of 0.95. The head-to-head trials included showed that simvastatin was better tolerated than atorvastatin (OR 0.61) and rosuvastatin (OR 0.49). Individuals randomised to pravastatin (OR 0.68) and simvastatin (OR 0.75) were less likely to stop treatment due to adverse events compared to those randomised to atorvastatin. Pravastatin (0.71) and simvastatin (0.70) had the highest combined score out of a total of 1.00 showing the most favourable tolerability and harm profile on the basis of discontinuation due to adverse events, myalgia, and transaminase and CK elevations.

What it means for GPs

The authors concluded: ‘According to the findings of this comprehensive analysis, there is consistently strong evidence on the comparatively favourable side effects profile of simvastatin and pravastatin - particularly at low to moderate doses - which should be favoured in clinical practice.’

Circulation 2013, online 9 July

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