Hydrophilic vs lipophilic statins in coronary artery disease: A meta-analysis of randomized controlled trials

Ibadete Bytyçi; Gani Bajraktari; Deepak L Bhatt; Charity J Morgan; Ali Ahmed; Wilbert S Aronow; Maciej Banach; Lipid and Blood Pressure Meta-analysis Collaboration (LBPMC) Group

doi:10.1016/j.jacl.2017.03.003

Hydrophilic vs lipophilic statins in coronary artery disease: A meta-analysis of randomized controlled trials

J Clin Lipidol. 2017 May-Jun;11(3):624-637. doi: 10.1016/j.jacl.2017.03.003. Epub 2017 Mar 14.

Authors

Ibadete Bytyçi¹, Gani Bajraktari², Deepak L Bhatt³, Charity J Morgan⁴, Ali Ahmed⁵, Wilbert S Aronow⁶, Maciej Banach⁷; Lipid and Blood Pressure Meta-analysis Collaboration (LBPMC) Group

Affiliations

¹ Clinic of Cardiology, University Clinical Centre of Kosovo, Prishtina, Kosovo.
² Clinic of Cardiology, University Clinical Centre of Kosovo, Prishtina, Kosovo; Medical Faculty, University of Prishtina, Prishtina, Kosovo.
³ Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA, USA.
⁴ VA Medical Center and George Washington University, Washington, DC, USA.
⁵ University of Alabama at Birmingham, Birmingham, AL, USA.
⁶ Division of Cardiology, Department of Medicine, New York Medical College, Valhalla, NY, USA.
⁷ Department of Hypertension, Medical University of Lodz, Lodz, Poland; Polish Mother's Memorial Hospital Research Institute (PMMHRI), Lodz, Poland; Cardiovascular Research Centre, University of Zielona Gora, Zielona Gora, Poland. Electronic address: maciejbanach@aol.co.uk.

PMID: 28506385
DOI: 10.1016/j.jacl.2017.03.003

Abstract

Introduction: Some available experimental studies have reported that hydrophilic statins might have advantages compared with lipophilic statins in patients with coronary artery disease (CAD). Therefore, we performed a meta-analysis of randomized controlled trials (RCTs) investigating the potential differences of lipophilic and hydrophilic statins in patients with CAD.

Methods: We systematically searched selected electronic databases up to September 2016 to select RCTs, which compared clinical outcomes of hydrophilic vs lipophilic statins. Primary endpoints were cardiovascular (CV) events: major adverse cardiac events, myocardial infarction, cardiac revascularization, stroke, CV death, CV hospitalization, and all-cause mortality. Secondary endpoints were safety parameters: drug discontinuation, statin-associated muscle symptoms and alanine aminotransferase level increase.

Results: A total of 11,697 patients from 11 RCTs, randomly allocated to lipophilic (n = 5736) or hydrophilic statins (n = 5961), with a mean follow-up 14 months, were included in the meta-analysis. In comparison with hydrophilic, the lipophilic statins showed similar risk reduction for major adverse cardiac events (relative risk = 0.969, 95% confidence interval [CI], 0.835-1.125, P = .682), myocardial infarction (0.880, 95% CI: 0.731-1.058, P = .174), CV death (0.757, 95% CI: 0.486-1.180, P = .219), and all-cause mortality (0.797, 95% CI: 0.590-1.075, P = .137), as well as cardiac revascularization, stroke, drug discontinuation, and statin-associated muscle symptoms. CV hospitalization was lower (0.789, 95% CI: 0.643-0.969, P = .024) and alanine aminotransferase elevation was higher (2.689, 95% CI: 1.841-3.954, P ≤ .001) in lipophilic than in hydrophilic-treated patients.

Conclusions: In conclusion, similarity between hydrophilic and lipophilic statins holds between various clinical CAD settings.

Keywords: Coronary artery disease; Hydrophilic statins; Lipophilic statins.

Publication types

Comparative Study
Meta-Analysis
Review

MeSH terms

Coronary Artery Disease / drug therapy*
Humans
Hydrophobic and Hydrophilic Interactions*
Hydroxymethylglutaryl-CoA Reductase Inhibitors / chemistry*
Hydroxymethylglutaryl-CoA Reductase Inhibitors / therapeutic use*
Randomized Controlled Trials as Topic / methods*
Treatment Outcome

Substances

Hydroxymethylglutaryl-CoA Reductase Inhibitors