Kamal Awad1, Dimitri P Mikhailidis2, Peter P Toth3,4, Steven R Jones4, Patrick Moriarty5,6, Gregory Y H Lip7, Paul Muntner8, Alberico L Catapano9,10, Michael J Pencina11, Robert S Rosenson12, Jacek Rysz13, Maciej Banach13,14,15. 1. Faculty of Medicine, Zagazig University, El-Sharkia, Zagazig, 44519, Egypt. kamal225244@medicine.zu.edu.eg. 2. Department of Clinical Biochemistry, Royal Free Campus, University College London Medical School, University College London (UCL), London, UK. 3. Preventive Cardiology, CGH Medical Center, Sterling, IL, USA. 4. The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA. 5. Division of Clinical Pharmacology, University of Kansas Medical Center, Kansas City, KS, USA. 6. Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, USA. 7. University of Birmingham Institute of Cardiovascular Sciences, City Hospital, Birmingham, UK. 8. Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA. 9. Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy. 10. IRCCS Multimedica, Milan, Italy. 11. Department of Biostatistics and Bioinformatics, Duke Clinical Research Institute, Chapel Hill, NC, USA. 12. Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA. 13. Department of Hypertension, WAM University Hospital in Lodz, Medical University of Lodz (MUL), Lodz, Poland. 14. Polish Mother's Memorial Hospital Research Institute, Lodz, Poland. 15. Cardiovascular Research Centre, University in Zielona Gora, Zielona Gora, Poland.
Abstract
PURPOSE: We conducted a meta-analysis of randomized controlled trials (RCTs) and quasi-RCTs to synthesize evidence about the efficacy and safety of alternate-day vs daily dosing of statins. METHODS: We searched selected databases through January 2, 2017 to identify relevant RCTs and quasi-RCTs. The primary outcome was change in low-density lipoprotein cholesterol (LDL-C), total cholesterol (TC), and triglycerides (TG), while secondary outcomes included adverse events and adherence. RESULTS: Twelve RCTs and 1 quasi-RCT (n = 1023 patients) were included in the analysis. Pooled analysis revealed no statistically significant difference between alternate-day and daily regimens of atorvastatin and rosuvastatin in terms of change in LDL-C (mean difference [MD] 6.79 mg/dL, 95% confidence interval [CI] -1.59, 15.17, p = 0.11, and 10.51 mg/dL, 95%CI -0.23, 21.26, p = 0.06, respectively) and TG (p > 0.05). Daily regimens of atorvastatin and rosuvastatin were superior to alternate-day regimes in term of change in TC (MD 12.45 mg/L, 95%CI 8.14, 16.76, p < 0.00001, and 15.80 mg/dL, 95%CI 5.66, 25.95, p = 0.002, respectively). For all outcomes, there was no statistically significant difference between alternate-day and daily regimens for both fluvastatin and pravastatin (p > 0.05). Both regimens of statins were generally well tolerated with good adherence. CONCLUSIONS: Alternate-day dosing of individual statins (especially atorvastatin and rosuvastatin) is as efficacious as daily dosing on LDL-C and TG.
PURPOSE: We conducted a meta-analysis of randomized controlled trials (RCTs) and quasi-RCTs to synthesize evidence about the efficacy and safety of alternate-day vs daily dosing of statins. METHODS: We searched selected databases through January 2, 2017 to identify relevant RCTs and quasi-RCTs. The primary outcome was change in low-density lipoprotein cholesterol (LDL-C), total cholesterol (TC), and triglycerides (TG), while secondary outcomes included adverse events and adherence. RESULTS: Twelve RCTs and 1 quasi-RCT (n = 1023 patients) were included in the analysis. Pooled analysis revealed no statistically significant difference between alternate-day and daily regimens of atorvastatin and rosuvastatin in terms of change in LDL-C (mean difference [MD] 6.79 mg/dL, 95% confidence interval [CI] -1.59, 15.17, p = 0.11, and 10.51 mg/dL, 95%CI -0.23, 21.26, p = 0.06, respectively) and TG (p > 0.05). Daily regimens of atorvastatin and rosuvastatin were superior to alternate-day regimes in term of change in TC (MD 12.45 mg/L, 95%CI 8.14, 16.76, p < 0.00001, and 15.80 mg/dL, 95%CI 5.66, 25.95, p = 0.002, respectively). For all outcomes, there was no statistically significant difference between alternate-day and daily regimens for both fluvastatin and pravastatin (p > 0.05). Both regimens of statins were generally well tolerated with good adherence. CONCLUSIONS: Alternate-day dosing of individual statins (especially atorvastatin and rosuvastatin) is as efficacious as daily dosing on LDL-C and TG.
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