The Use of High Intensity Statin Therapy with Simvastatin 80mg and Atorvastatin 80mg in Primary Care

Claire Louise Meek (1) , Jonathan Reston (2) , Tim Ramsbottom (3) , Hari Pathmanathan (4) , Adie Viljoen (5)

1 Chemical Pathology
2 Centre for Lifespan and Chronic Illness Research
3 Nevells Road Surgery
4 Bridge Cottage Surgery
5 Clinical Biochemistry

Abstract Aims: Cardiovascular disease (CVD) is the most common cause of death worldwide. Pharmaceutical risk reduction with high-intensity statin therapy is advisable for high risk patients. Clinicians face a conflict between prescribing for cost (simvastatin 80mg) or for efficacy (atorvastatin 80mg). The aim of this audit was to examine the use, efficacy and tolerability of high intensity statin treatment (simvastatin 80mg; atorvastatin 80mg) in primary care. Method: Electronic medical records were examined from two general practitioners' surgeries. Analysis involved Mann-Whitney U and Chi-squared tests. Results: 116 patients had taken simvastatin 80mg or atorvastatin 80mg. Patients were similar between treatment groups: mostly male (62.9%), over 60 years old (68.1%) non-smokers (81.0%) taking statins for secondary prevention (56.9%). More patients on simvastatin withdrew from treatment due to inefficacy (49.3% versus 23.2%, p=0.025) compared to the atorvastatin group. Furthermore, patients on simvastatin were more likely to be failing conventional targets of lipid control, compared with patients on atorvastatin 80mg (43.5% versus 21.3%, p=0.006). Tolerability was similar between the two groups. Discussion: UK guidelines recommend simvastatin 80mg as an economic choice, despite scant evidence at this dose and recent safety concerns. Conversely, robust evidence exists for atorvastatin 80mg. Head-to-head clinical trials or clinical studies comparing these agents are lacking. The present study suggests that atorvastatin 80mg compares favourably to simvastatin in terms of efficacy and has a similar tolerability profile. Conclusion: This retrospective observational study suggests that despite national guidelines, atorvastatin 80mg is used in clinical practice and is more effective and at least as well tolerated as simvastatin 80mg.

Mots clés: Medicine

Claire Louise Meek, Jonathan Reston, Tim Ramsbottom, Hari Pathmanathan, Adie Viljoen. The Use of High Intensity Statin Therapy with Simvastatin 80mg and Atorvastatin 80mg in Primary Care. International Journal of Clinical Practice, 2011, 65 (2), pp.120. ⟨10.1111/j.1742-1241.2010.02570.x⟩. ⟨hal-00613816⟩