Bayesian Meta-Analysis: The Effect of Statins on the Treatment of Hypercholesterolemia

Statins inhibit cholesterol synthesis by blocking 3-hydroxy-3-methylglutaryl coenzyme A reductase in the liver, thereby ameliorating hypercholesterolemia. Thus, to determine statins with the best efficacy, a meta-analysis was performed to compare the effects of statins against hypercholesterolemia. Comprehensive literature searches were established, from Cochrane library, Pubmed, Embase. The studies were performed to randomize controlled trials (RCTs), cohort studies or case-control studies about efficacy of different statin drugs and dose against hypercholesterolemia published between 1997 and 20 February, 2017. Study qualities were assessed according to Cochrane collaboration recommendations. The non-programming software Aggregate Data Drug Information System (ADDIS) (version 1.16.5) was used to perform Bayesian network meta-analysis and compare treatments using the MarkovChain Monte Carlo (MCMC) method. Overall, 28 RCTs studies, including 12855 patients, met the inclusion criteria. Total cholesterol (TC) levels significantly reduced (p<0.05) using 2 mg Pitavastatin (Pit) than those using 20 mg Pravastatin (Pra),10 mg Simvastatin (Sim) or 10 mg Atorvastatin (Ato). Similarly,triglyceride (TG) levels reduced using 2 mg Pit than those using 20 mg Pra (p<0.05), 10 mg Sim (p<0.05) or 20 mg Sim (p<0.05) and reduced apolipoprotein B (Apo B) levels were observed than those using 10 mg Ato or 20 mg Pra (p<0.05). Rosuvastatin (Ros) significantly reduced TC and TG levels (p<0.05) when administered at 20 and 10 mg Ros treatments ameliorated percentage changes in low-density lipoprotein cholesterol more than the other drugs (p<0.05) and increased high-density lipoprotein cholesterol levels more effectively than 10 mg Ato (p<0.05), 20 mg Pra (p<0.05) or 10 mg Sim (p<0.05). Increases in Apo Al levels did not differ between treatments (p>0.05). Among the present statin drug regimens, 2 mg Pit and 10 or 20 mg Ros had the highest efficacy against hypercholesterolemia.