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Use of atorvastatin in lipid disorders and cardiovascular disease in Chinese patients.

Ye YC, Zhao XL, Zhang SY - Chin. Med. J. (2015)

Bottom Line: Atorvastatin is a reversible and competitive inhibitor of 3-hydroxy-3-methylglutaryl-coenzyme A reductase, decreasing the de novo cholesterol synthesis.The pharmacokinetics of atorvastatin among Chinese is similar to those in Caucasians, and several gene polymorphisms have proved to be associated with the metabolism of atorvastatin in the Chinese population.Based on the current available evidence, there is no significant difference between Chinese and non-Chinese population in term of pharmacology and clinical efficacy/safety.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China.

ABSTRACT

Objective: Statins are still underused for the prevention of cardiovascular disease (CVD) in China. Hence, we conducted a systemic review on the pharmacology, clinical efficacy, and adverse events of atorvastatin, as well as on patient adherence.

Data sources: We conducted a systemic search in PubMed with the following keywords: "atorvastatin" (Supplementary concept) or "atorvastatin" (All field) and ("China" [AD] or "China" [all field] or "Chinese" [All field]).

Study selection: Clinical or basic research articles on atorvastatin were included.

Results: Atorvastatin is a reversible and competitive inhibitor of 3-hydroxy-3-methylglutaryl-coenzyme A reductase, decreasing the de novo cholesterol synthesis. The pharmacokinetics of atorvastatin among Chinese is similar to those in Caucasians, and several gene polymorphisms have proved to be associated with the metabolism of atorvastatin in the Chinese population. Several international multiple-center randomized control trials have demonstrated the benefit of atorvastatin for primary and secondary prevention of CVD. None of them, however, included the Chinese, and current evidence in the population is still inadequate, due to the small sample size, low study quality, short study duration, and the use of surrogate endpoints instead of clinical endpoints. The overall incidence of adverse events observed with atorvastatin did not increase in the 10-80 mg dose range, and was similar to that observed with placebo and in patients treated with other statins, which makes atorvastatin well-tolerated in the Chinese population. Moreover, high patient adherence was observed in clinical studies.

Conclusions: Based on the current available evidence, there is no significant difference between Chinese and non-Chinese population in term of pharmacology and clinical efficacy/safety. High-quality evidence is still needed to support the use of atorvastatin in high-risk Chinese population.

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Pooled results of safety outcomes for atorvastatin in Chinese population.
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Figure 1: Pooled results of safety outcomes for atorvastatin in Chinese population.

Mentions: To fully evaluate the safety and adherence of atorvastatin in the Chinese population, we conducted a systemic search of the literature in PubMed using the keywords “atorvastatin” (Supplementary concept) or “atorvastatin” (All field) and (“China” [AD] or “China” [all field] or “Chinese” [All field]) to identify all the RCTs comparing atorvastatin with control/placebo or other statins and reporting the incidence of side-effect. Thirteen RCTs with 4,145 patients were finally included [Table 2].[27334142434849505152535455] The incidence of hepatic and musculoskeletal toxicity and the adherence of medication were pooled using the Mantel-Haenszel Method with random effect model (STATA 11.0; STATA Corp., TX, USA). No case of rhabdomyolysis or CK > 10 ULN was reported. The risk of hepatic and musculoskeletal toxicity did not differ between atorvastatin and control/placebo groups, as well as the adherence of medication. Besides, atorvastatin has a similar risk of hepatic and musculoskeletal toxicity and adherence of medication with other statins. When compared with low-dose atorvastatin (10–20 mg/day), high-dose atorvastatin (40–80 mg/day) has a significantly higher risk of elevated ALT. However, the risk of elevated ALT > 3 ULN, as well as the risk of musculoskeletal toxicity and adherence to medications, did not differ between high-dose and low-dose atorvastatin. Thus, the overall incidence of significant adverse events observed with atorvastatin in Chinese population was similar to that observed with placebo or other statins [Figure 1].


Use of atorvastatin in lipid disorders and cardiovascular disease in Chinese patients.

Ye YC, Zhao XL, Zhang SY - Chin. Med. J. (2015)

Pooled results of safety outcomes for atorvastatin in Chinese population.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4837848&req=5

Figure 1: Pooled results of safety outcomes for atorvastatin in Chinese population.
Mentions: To fully evaluate the safety and adherence of atorvastatin in the Chinese population, we conducted a systemic search of the literature in PubMed using the keywords “atorvastatin” (Supplementary concept) or “atorvastatin” (All field) and (“China” [AD] or “China” [all field] or “Chinese” [All field]) to identify all the RCTs comparing atorvastatin with control/placebo or other statins and reporting the incidence of side-effect. Thirteen RCTs with 4,145 patients were finally included [Table 2].[27334142434849505152535455] The incidence of hepatic and musculoskeletal toxicity and the adherence of medication were pooled using the Mantel-Haenszel Method with random effect model (STATA 11.0; STATA Corp., TX, USA). No case of rhabdomyolysis or CK > 10 ULN was reported. The risk of hepatic and musculoskeletal toxicity did not differ between atorvastatin and control/placebo groups, as well as the adherence of medication. Besides, atorvastatin has a similar risk of hepatic and musculoskeletal toxicity and adherence of medication with other statins. When compared with low-dose atorvastatin (10–20 mg/day), high-dose atorvastatin (40–80 mg/day) has a significantly higher risk of elevated ALT. However, the risk of elevated ALT > 3 ULN, as well as the risk of musculoskeletal toxicity and adherence to medications, did not differ between high-dose and low-dose atorvastatin. Thus, the overall incidence of significant adverse events observed with atorvastatin in Chinese population was similar to that observed with placebo or other statins [Figure 1].

Bottom Line: Atorvastatin is a reversible and competitive inhibitor of 3-hydroxy-3-methylglutaryl-coenzyme A reductase, decreasing the de novo cholesterol synthesis.The pharmacokinetics of atorvastatin among Chinese is similar to those in Caucasians, and several gene polymorphisms have proved to be associated with the metabolism of atorvastatin in the Chinese population.Based on the current available evidence, there is no significant difference between Chinese and non-Chinese population in term of pharmacology and clinical efficacy/safety.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China.

ABSTRACT

Objective: Statins are still underused for the prevention of cardiovascular disease (CVD) in China. Hence, we conducted a systemic review on the pharmacology, clinical efficacy, and adverse events of atorvastatin, as well as on patient adherence.

Data sources: We conducted a systemic search in PubMed with the following keywords: "atorvastatin" (Supplementary concept) or "atorvastatin" (All field) and ("China" [AD] or "China" [all field] or "Chinese" [All field]).

Study selection: Clinical or basic research articles on atorvastatin were included.

Results: Atorvastatin is a reversible and competitive inhibitor of 3-hydroxy-3-methylglutaryl-coenzyme A reductase, decreasing the de novo cholesterol synthesis. The pharmacokinetics of atorvastatin among Chinese is similar to those in Caucasians, and several gene polymorphisms have proved to be associated with the metabolism of atorvastatin in the Chinese population. Several international multiple-center randomized control trials have demonstrated the benefit of atorvastatin for primary and secondary prevention of CVD. None of them, however, included the Chinese, and current evidence in the population is still inadequate, due to the small sample size, low study quality, short study duration, and the use of surrogate endpoints instead of clinical endpoints. The overall incidence of adverse events observed with atorvastatin did not increase in the 10-80 mg dose range, and was similar to that observed with placebo and in patients treated with other statins, which makes atorvastatin well-tolerated in the Chinese population. Moreover, high patient adherence was observed in clinical studies.

Conclusions: Based on the current available evidence, there is no significant difference between Chinese and non-Chinese population in term of pharmacology and clinical efficacy/safety. High-quality evidence is still needed to support the use of atorvastatin in high-risk Chinese population.

Show MeSH
Related in: MedlinePlus