Major Findings

Studies have shown that statins can have beneficial effects beyond their cholesterol-lowering ability. These effects include modifying thrombus formation and degradation, altering inflammatory responses, stabilizing plaque, and improving endothelial function. 1 However, it is not clear whether all statins have the same effects. 1

A study comparing pitavastatin and atorvastatin in Korean adults with high cholesterol found no significant difference in the proportion of patients achieving their LDL-C goal, the reductions in LDL-C, total cholesterol, and triglycerides, or the increases in HDL-C between the two groups. 5 Both drugs were well tolerated. 5

Another study comparing pitavastatin and atorvastatin showed that pitavastatin was superior to atorvastatin in improving endothelial function in the short term. 4 Pitavastatin may be a potentially better therapeutic choice for lipid-lowering and early changes in endothelial function. 4

A study comparing the effects of atorvastatin and rosuvastatin on lipids and inflammation markers in patients with non-ST-elevation acute coronary syndrome (NSTEACS) found that rosuvastatin 10mg did not produce the same changes in lipids and inflammation markers as atorvastatin 40mg. 7 Rosuvastatin's effect on lipids was somewhat inferior to atorvastatin 40mg. 7 Interestingly, atorvastatin and rosuvastatin did not have a significant effect on inflammation markers during the first 14 days of NSTEACS, possibly due to insufficient doses of both drugs. 7

A study comparing the effects of simvastatin and atorvastatin on oxidative stress in patients with coronary heart disease (CHD) found that atorvastatin reduced oxidative stress more effectively than simvastatin. 9 Changes in oxidative stress markers did not correlate with changes in plasma lipid profiles. 9

A study evaluating the combination therapy of probucol, aspirin, and atorvastatin (PAS) found that PAS therapy significantly inhibited the generation of oxidized LDL and MMP-9, reduced plaque thickness, and decreased the rate of adverse events in patients with atherosclerosis. 6 Antioxidants can be considered as a new adjunct therapy in the treatment of atherosclerosis. 6

A study investigating the effect of a single high loading dose of rosuvastatin on preventing peri-procedural myocardial injury in patients undergoing percutaneous coronary intervention (PCI) found that rosuvastatin 40mg administered 24 hours before PCI significantly reduced the incidence of peri-procedural myocardial necrosis and infarction compared to the control group. 8

Atorvastatin may cause a reduction in levels of testosterone and other androgens by reducing the level of cholesterol, which is a precursor in the steroidogenesis pathway. 10 Testosterone and other androgens play important roles in biological functions. 10 A potential reduction in androgen levels caused by atorvastatin might cause negative effects in most settings. 10 However, in the setting of polycystic ovary syndrome (PCOS), reducing excessive levels of androgens with atorvastatin could be beneficial. 10

A study comparing simvastatin and atorvastatin found that atorvastatin was more effective than simvastatin on lipid parameters, although statistically insignificant, while simvastatin produced more significant changes than atorvastatin on hemostatic parameters. 3 The mean dose of simvastatin was greater than that of atorvastatin. 3 Both statins had increased effects on lipid and hemostatic parameters when doses were increased. 3 Atorvastatin and simvastatin were well tolerated. 3

A study comparing atorvastatin and pravastatin found that high-dose atorvastatin and pravastatin both reduced CRP levels. 2 However, while pravastatin's effect on CRP was independent of lipid-lowering efficacy, atorvastatin-induced CRP reductions correlated directly to the change in low-density lipoprotein-C. 2

Benefits and Risks

Benefits Summary

Statins can have beneficial effects beyond lowering cholesterol, which may reduce the risk of cardiovascular events. 1 These effects include modifying thrombus formation and degradation, altering inflammatory responses, stabilizing plaque, and improving endothelial function. 1 Certain statins, like pitavastatin, may be superior to atorvastatin in improving endothelial function in the short term. 4

Risks Summary

The main side effects of statins include muscle pain, liver dysfunction, and rhabdomyolysis. 1 Statins can also reduce levels of testosterone and other androgens, which may affect some patients. 10

Comparison Between Studies

Similarities

These studies suggest that statins may have beneficial effects beyond their cholesterol-lowering ability, including anti-inflammatory, hemostatic, and antioxidant effects. 1 However, these effects may vary depending on the statin and further research is needed. 1

Differences

These studies compare different statins and investigate different effects. 1 For example, pitavastatin may be better for endothelial function than atorvastatin, while atorvastatin may be better for oxidative stress than simvastatin. 4 9 Additionally, these studies were conducted with different patient populations, making it difficult to directly compare the results. 1

Consistency and Discrepancies in Results

There is consistent evidence that statins have beneficial effects beyond lowering cholesterol. 1 However, these effects may vary depending on the statin, dose, and patient population. 1 Further research is needed, especially in investigating the class effect of statins. 1

Considerations for Real-Life Application

Statins are important medications for reducing the risk of cardiovascular disease. 1 However, statins are not suitable for all patients. 1 The use of statins should be determined in consultation with a doctor based on the individual patient's risk factors and potential side effects. 1

Limitations of Current Research

These studies were relatively small and further investigation is required. 1 Additionally, these studies focused on specific statins and cannot fully assess the class effect of statins. 1

Future Research Directions

Future research should include larger studies comparing different statins and evaluating the class effect of statins. 1 Additionally, these studies should investigate the long-term effects of statins. 1

Conclusion

Statins are effective and widely used medications for reducing the risk of cardiovascular disease. 1 Statins may have beneficial effects beyond lowering cholesterol, and these effects may vary depending on the statin. 1 More research is needed regarding the safety and effectiveness of statins. 1