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Cholesterol: pravastatin and simvastatin
are the first-line drugs

In cardiovascular prevention, pravastatin and simvastatin are the cholesterol-lowering statins that have the longest track record and whose effectiveness is the most convincing.

In cardiovascular prevention, pravastatin and simvastatin reduce the overall mortality rate and the number of new cases of myocardial infarction. They have similar rates of effectiveness and adverse effects profiles.

Of the most recent statins, atorvastatin is the one whose clinical evaluation is the most advanced. However, it does not appear to be any more effective than the equivalent dose of pravastatin or simvastatin.

It has not been proven that fluvastatin is any more effective in cardiovascular prevention than pravastatin or simvastatin. Rosuvastatin has not been thoroughly evaluated clinically and causes more severe renal and muscular adverse effects than other statins.

In practice, when a statin is necessary in cardiovascular prevention, pravastatin and simvastatin remain the first-line statins. Pravastatin presents fewer risks of interaction with some drugs or grapefruit juice.

©Prescrire October 2006

Source: "Choix d'une statine : pravastatine et simvastatine sont mieux éprouvées que l'atorvastatine" Rev Prescrire 2006 ; 26 (276) : 692-695.

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