Cholesterol
|
Drug |
Reported
Cases of Fatal Rhabdomyolysis |
Cerivastatin |
3.16 |
Lovastatin |
0.19 |
Simvastatin |
0.12 |
Pravastatin |
0.04 |
Atorvastatin |
0.04 |
Fluvastatin |
0.00 |
Rosuvastatin |
0.00 |
Risk: To put risk and benefit in a clearer perspective, for every 100,000 patients with statins in large secondary outcome trials 4 will suffer rhabdomyolysis and 33 will suffer myositis
Benefit: Extrapolated to 100,000 patients, the benefits of statin therapy are:
4S Trial (6 years): prevention of 4000 deaths, 7000 nonfatal heart attacks and 6000 myocardial revascularization procedures.
CARE (5 years): prevention of 15000 cardiovascular events in unselected patients, 20700 cardiovascular events in patients > age 60 and 22800 cardiovascular events in women
LIPID (6.1 years): prevention of 3000 deaths, 2800 non-fatal heart attacks, 900 strokes, 2300 bypass surgeries, 2000 angioplasties and 8200 admissions for unstable angina.
HPS (5 years): prevention of 7000-10000 heart attacks, stroke or revascularization procedures.
PROVE-IT (18-36 months-mean 24 months) high dose versus moderate dose statin in patients with acute coronary syndromes demonstrates an incremental benefit of 3.9 % absolute and 16% relative risk reduction in the primary end-point - a composite of death from any cause, myocardial infarction, documented unstable angina requiring re-hospitalization, revascularization (performed at least 30 days after randomization), and stroke. For 100,000 patients treated this means the prevention of 3900 further events.
TNT (4.9 years) high dose vs low dose statin in a chronic CHD population showed similar incremental benefits on combined cardiovascular endpoints (death from CHD, nonfatal non-procedure-related myocardial infarction, resuscitation after cardiac arrest or fatal or nonfatal stroke). The incremental benefit was 2.2 % absolute and relative risk reduction of 22%. For 100,000 patients treated this means the prevention of 3400 major cardiovascular events.
In summary:
References:
2. Olsson GO. Safety and efficacy of rosuvastatin. www.thelancet.com Vol 354 July 10, 2004.
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