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Lipophilic Statin Versus Rosuvastatin (Hydrophilic) Treatment for Heart Failure: a Meta-Analysis and Adjusted Indirect Comparison of Randomised Trials

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Abstract

Objectives

This study aims to compare lipophilic and hydrophilic statin therapy on clinical outcomes of heart failure (HF) using a systematic review and an adjusted indirect comparison meta-analysis. Outcomes were all-cause mortality, cardiovascular mortality, cardiovascular hospitalization and hospitalization for worsening HF.

Methods

We conducted a search of PubMed, EMBASE and Cochrane databases until 31st December 2014 for randomized control trials (RCTs) in HF evaluating statins versus placebo. Identified RCTs and their respective abstracted information were grouped according to statin type evaluated and analyzed separately. Outcomes were initially pooled with the Peto’s one-step method, producing odd ratios (OR) and 95 % confidence intervals (CI) for each statin type. Using these pooled estimates, we performed adjusted indirect comparisons of lipophilic versus hydrophilic statin for each outcome.

Results

Thirteen studies involving 10,966 patients were identified and analyzed. Lipophilic statins were superior to hydrophilic rosuvastatin regarding all-cause mortality (OR 0 · 50; 95 % CI, 0 · 11–0 · 89; p = 0 · 01), cardiovascular mortality (OR 0 · 61; 0 · 25–0 · 97; p = 0 · 009), and hospitalization for worsening HF (OR 0 · 52; 0 · 21–0 · 83; p = 0 · 0005). However, both statins were comparable with regards to cardiovascular hospitalization [OR 0 · 80 (0 · 31, 1 · 28); p = 0 · 36].

Conclusions

Lipophilic statin treatment shows significant decreases in all-cause mortality, cardiovascular mortality and hospitalization for worsening HF compared with rosuvastatin treatment. This meta-analysis provides preliminary evidence that lipophilic statins offer better clinical outcomes in HF till data from head to head comparisons are available.

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Acknowledgments

We are grateful to Dr Lee Chiang Sheng (LCS) and Dr Vishnuprasad Baktavatsalam (VB) for the technical assistance.

Authors’ Contributions

KOB conceived the original idea and refined it with AK and DDR. KOB wrote the initial draft and conducted the analysis of the data. AK and DDR contributed to subsequent drafts. All authors edited and approved the final manuscript.

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Authors and Affiliations

  1. School of Medicine and Health Sciences, Monash University, Sunway Campus, Jalan Lagoon Selatan, Bandar Sunway, 46150, Selangor DE, Malaysia

    Kwadwo Osei Bonsu, Daniel Diamond Reidpath & Amudha Kadirvelu

  2. Pharmacy Department, Accident and Emergency Directorate, Komfo Anokye Teaching Hospital, P.O. Box 1934, Kumasi, Ghana

    Kwadwo Osei Bonsu

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  1. Kwadwo Osei Bonsu
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Correspondence to Kwadwo Osei Bonsu.

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Bonsu, K.O., Reidpath, D.D. & Kadirvelu, A. Lipophilic Statin Versus Rosuvastatin (Hydrophilic) Treatment for Heart Failure: a Meta-Analysis and Adjusted Indirect Comparison of Randomised Trials. Cardiovasc Drugs Ther 30, 177–188 (2016). https://doi.org/10.1007/s10557-015-6636-z

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