title: Adverse events associated with individual statin treatments for cardiovascular disease: an indirect comparison meta-analysis.
abstract: BACKGROUND
  Statins are the most widely prescribed drug available. Due to this reason, it is important to understand the risks involved with the drug class and individual statins.
  
  
  OBJECTIVE
  We conducted a meta-analysis and employed indirect comparisons to identify differing risk effects across statins.
  
  
  METHODS
  We included any randomized clinical trial (RCT) of atorvastatin, fluvastatin, lovastatin, pitavastatin, pravastatin, rosuvastatin and simvastatin used for cardiovascular disease event prevention. The main outcome was adverse events [all-cause mortality, cancers, rhabdomylosis, diabetes, aspartate and alanine aminotransferase (AST/ALT), and creatinine kinase (CK) increases beyond the upper limit of normal]. In order to evaluate the relative effects of each drug on adverse events, we calculated adjusted indirect comparisons of the adverse-event outcomes.
  
  
  RESULTS
  Seventy-two trials involving 159,458 patients met our inclusion criteria. Overall, statin treatments significantly increased the rate of diabetes when compared to controls (OR: 1.09; 95% CI: 1.02-1.16) and elevated AST (OR: 1.31; 95% CI: 1.04-1.66) and ALT (OR: 1.28; 95% CI: 1.11-1.48) levels when compared to controls. Using indirect comparisons, we also found that atorvastatin significantly elevated AST levels compared to pravastatin (OR: 2.21; 95% CI: 1.13-4.29) and simvastatin significantly increased CK levels when compared to rosuvastatin (OR: 4.39; 95% CI: 1.01-19.07). Higher dose studies had increased risk of AST elevations.
  
  
  CONCLUSIONS
  Although statins are generally well tolerated, there are risks associated with almost all drugs. With few exceptions, statins appear to exert a similar risk across individual drugs.
authors.affiliation: Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: M
authors.initials: M
authors.lastname: Alberton
authors.forename: P
authors.initials: P
authors.lastname: Wu
authors.forename: E
authors.initials: E
authors.lastname: Druyts
authors.forename: M
authors.initials: M
authors.lastname: Briel
authors.forename: E J
authors.initials: EJ
authors.lastname: Mills
mesh_terms: D000328:Adult; D000368:Aged; D000410:Alanine Transaminase / Q000378:metabolism; D001224:Aspartic Acid / Q000378:metabolism; D002318:Cardiovascular Diseases / Q000401:mortality / Q000517:prevention & control*; D003404:Creatinine / Q000378:metabolism; D003920:Diabetes Mellitus / Q000139:chemically induced; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000139:chemically induced; D016032:Randomized Controlled Trials as Topic; D012206:Rhabdomyolysis / Q000139:chemically induced
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D001224:Aspartic Acid; D003404:Creatinine; D000410:Alanine Transaminase