title: Use of high-intensity statin therapy with simvastatin 80 mg and atorvastatin 80 mg in primary care.
abstract: OBJECTIVE
  Cardiovascular disease (CVD) is the most common cause of death worldwide. Pharmaceutical risk reduction with high-intensity statin therapy is advisable for high-risk patients. Clinicians face a conflict between prescribing for cost (simvastatin 80 mg) or for efficacy (atorvastatin 80 mg). The aim of this audit was to examine the use, efficacy and tolerability of high intensity statin treatment (simvastatin 80 mg; atorvastatin 80 mg) in primary care.
  
  
  METHODS
  Electronic medical records were examined from two general practitioners' surgeries. Analyses involved Mann-Whitney U and χ(2) tests.
  
  
  RESULTS
  A total of 116 patients had taken simvastatin 80 mg or atorvastatin 80 mg. Patients were similar between treatment groups: mostly men (62.9%), over 60 years old (68.1%), non-smokers (81.0%) taking statins for secondary prevention (56.9%). More patients on simvastatin withdrew from treatment as a result of inefficacy (49.3% vs. 23.2%, p=0.025) compared with the atorvastatin group. Furthermore, patients on simvastatin were more likely to be failing conventional targets of lipid control, compared with patients on atorvastatin 80 mg (43.5% vs. 21.3%, p=0.006). Tolerability was similar between the two groups.
  
  
  CONCLUSIONS
  UK guidelines recommend simvastatin 80 mg as an economic choice, despite scant evidence at this dose and recent safety concerns. Conversely, robust evidence exists for atorvastatin 80 mg. Head-to-head clinical trials or clinical studies comparing these agents are lacking. The present study suggests that atorvastatin 80 mg compares favourably to simvastatin in terms of efficacy and has a similar tolerability profile.
  
  
  CONCLUSIONS
  This retrospective observational study suggests that despite national guidelines, atorvastatin 80 mg is used in clinical practice and is more effective and at least as well tolerated as simvastatin 80 mg.
authors.affiliation: Department of Chemical Pathology, Lister Hospital, Stevenage, UK. claire.meek@nhs.net
authors.forename: C L
authors.initials: CL
authors.lastname: Meek
authors.forename: J D
authors.initials: JD
authors.lastname: Reston
authors.forename: T
authors.initials: T
authors.lastname: Ramsbottom
authors.forename: H
authors.initials: H
authors.lastname: Pathmanathan
authors.forename: A
authors.initials: A
authors.lastname: Viljoen
mesh_terms: D000328:Adult; D000368:Aged; D000069059:Atorvastatin; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000097:blood / Q000188:drug therapy*; D004739:England; D005194:Family Practice / Q000592:standards; D005260:Female; D006538:Heptanoic Acids / Q000008:administration & dosage*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage*; D008055:Lipids / Q000097:blood; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D011758:Pyrroles / Q000008:administration & dosage*; D011787:Quality of Health Care; D012189:Retrospective Studies; D019821:Simvastatin / Q000008:administration & dosage*
chemical_list: D006538:Heptanoic Acids; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D008055:Lipids; D011758:Pyrroles; D000069059:Atorvastatin; D019821:Simvastatin