Results of the Heart Protection Study: Can we still assume a class effect?

Statins share several common features including the mechanism of action, i.e. inhibition of HMG-CoA reductase, as well as LDL-cholesterol (LDL-C) and triglyceride lowering properties. However, statins show minor differences in chemical structure, lipophilicity that could translate into a different pharmacological properties. For example, simvastatin exerted a more favorable effect on HDL-C levels than did atorvastatin when higher doses of the two drugs were compared. Finally, the major considerations to chose between statins for CVD patient therapy include clinical benefits and safety (i.e. evidence-based medicine). Primary prevention trials with pravastatins and lovastatin and secondary prevention trials with pravastatin, fluvastatin and simvastatin have established the clinical benefits of statins. In addition, HPS study was designed to investigate the benefits of simvastatin 40 mg in a broad range of patients at high risk for heart disease including women, the elderly and those with a history of hearth attacks, diabetes, hypertension or vascular disease. The results show the ability of simvastatin to reduce all causes of mortality, vascular death and cardiovascular morbidity. The trial also confirms the safety of simvastatin 40 mg although 60% of patients were receiving additional pharmacological treatment. In summary, it appears that statins are not the same and the choice of the more appropriate statin in high-risk patients should be driven by the evidence-based medicine both in terms of safety and efficacy.