A systematic review 1 was abstracted in DARE. Atorvastatin (2.5 mg to 80 mg per day) lowered LDL-cholesterol by 35% to 61% and triglycerides by 14% to 45% compared to placebo. One trial showed atorvastatin 10 to 20 mg/day led to significantly greater reductions in TC, TG and LDL-C compared to pravastatin 20 to 40 mg/day, and two trials showed that atorvastatin 10 to 20 mg/day led to significantly greater reductions in TC, TG and LDL-C compared to simvastatin 10 to 20 mg/day.
Comment: The quality of evidence is downgraded by indirectness of evidence (difference in equivalent doses) and study limitations. Clinical endpoints (mortality and morbidity) should be assessed rather than laboratory results. The authors conclude that due to omissions in reporting the primary studies, the presence of many treatment arms with small numbers of patients, and failure to discuss equivalent doses of drugs make it difficult to comment on the comparative efficacy of atorvastatin. According to a meta-analysis 2, atorvastatin was 2 to 4 times as potent as simvastatin in reducing TC, LDL-C, and TG, indicating that the dose equivalence of atorvastatin and simvastatin lay between 1:2 and 1:4.
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