"We are not surprised by the findings, despite claims for certain statins being 'better' than others," says lead author Frank Z. Zhou, MD, of McGill University, Montreal. "At regular prescribed doses, we found that choice of statin does not make a difference in preventing recurrent AMI or death."

In this 5-year retrospective cohort study, Dr. Zhou et al compared 5 statins using data from medical administrative databases in 3 provinces (Quebec, Ontario, and British Columbia). Participants (age 65 and older) were discharged alive after their first AMI-related hospital stay and had begun statin treatment within 90 days after discharge. Primary endpoint was the combined outcome of recurrent AMI or death from any cause.

A total of 18,637 patients were prescribed atorvastatin, pravastatin, simvastatin, lovastatin, or fluvastatin. Adjusted HRs (and 95% CI) for the combined outcome of AMI or death showed that each statin had similar effects when compared with atorvastatin: pravastatin, 1.00 (0.90-1.11); simvastatin, 1.01 (0.91-1.12), lovastatin, 1.09 (0.95-1.24), and fluvastatin, 1.01 (0.80-1.27). Results did not change when death alone was the endpoint, nor did they change after censoring of patients who switched or stopped the initial statin treatment.

"Statins used at their regular prescribed doses as found in the study appeared to be equivalent to reducing incidence of recurrent AMI or death in older patients who had a recent AMI," Dr. Zhou said. "Practice should be centered around the control of cholesterol, instead of the type of statin prescribed. Regular cholesterol check-ups according to guideline recommendations are necessary."

Source: CMAJ 2005; 172(9):1187-94.

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