Take Home Points?

-Statin tolerability is high among most patients

-Statins are not associated with an increased risk of cancer but do result in higher risk of DM (OR, 1.09; 95% CI)

-Patients on statins have significantly higher odds of clinically meaningful elevations in liver enzymes when compared to randomized controls (n=122,665; OR, 1.51; 95% CI)

-Simvastatin and pravastatin are tolerable than other statins

What is known?

Evidence from large trials shows the frequency of clinical side effects associated with statin therapy is low.

On a population level, there is no difference between individual statins and control in terms of rates of myalgia, creatine kinase elevation, cancer and discontinuation due to adverse events.

However, there is no comprehensive analysis which reviews randomized clinical trials evaluating different statins in individuals with and without cardiovascular disease, or renal disease.

Methods and Analysis?

Studies included from January 1985 to March 2013.

Open-label and double-blind RCTs comparing one statin with another at any dose or with controls (placebo, diet or usual care) for adults with CAD, or at risk of CAD.

Outcomes: tolerability, hepatic transaminases elevation x3 baseline, CK elevations, myalgia (pain), myopathy, and rhabdomyolysis, the incidence of cancer, the incidence of DM.

Excluded patients with renal insufficiency.

Results?

122,665 subjects randomized to statins had significantly higher odds of meaningful elevations in transaminases (OR, 1.51;95% CI)

113,698 subjects showed that statins as a class had statistically significant odds of diabetes mellitus compared with control (OR, 1.09;95% CI)

There was no statistically detectable difference between individual statins in terms of DM incidence.

References:

1. Naci, Huseyin, Brugts, Jasper, and Tony Ades. (2013). Comparative Tolerability and Harms of Individual Statins : A Study-Level Network Meta-Analysis of 246 955 Participants From 135 Randomized Controlled Trials. Circ Cardiovasc Qual Outcomes