This poster was presented to pharmacy students and faculty. The poster looked into the comparative efficacy of Simvastatin vs Pravastatin in primary endpoints of hypercholesterolemia. As a group, we were given a large data and used SPSS software to narrow down specific measurable endpoints.
Comparative Efficacy of Simvastatin vs Pravastatin in Primary Endpoints of Hypercholesterolemia Poster Project .pdf
1. Comparative efficacy of pravastatin versus simvastatin on LDL and total
cholesterol in patients with hypercholesterolemia
Lauryn Conti, Drew Hurley, Thomas Shugart, Jonathan Strandberg, Bekk Trojan
The University of Rhode Island, College of Pharmacy
Background
• Patients with hypercholesterolemia have been associated with a
two-fold increased risk for cardiovascular disease (CVD);
including potentially fatal stroke and myocardial infarction.
Statins lower LDL-C via inhibition of HMG-CoA reductase and are
associated with reduced cardiovascular morbidity and mortality1.
• Simvastatin has historically been more widely used due to its
high potency and efficacy. Although less potent, pravastatin is
correlated with less long-term kidney and muscle damage in
contrast with other statin medications2.
• Previous trials have found simvastatin to be superior to
pravastatin in lowering LDL-C and total cholesterol with
comparable tolerance[2,3].
Objectives
• The objective of this study was to evaluate the comparative
efficacy of pravastatin vs. simvastatin based on measured
LDL-C and total cholesterol values.
Methods
• Study Design/Data Source: A cross sectional analysis
was conducted using the National Health and Nutrition
Examination Survey (NHANES) 2017-2018 cycle dataset. The
data was unweighted.
• Exposure Definition: Participants reported use of pravastatin
or simvastatin in the 30 days prior to survey data collection.
• Outcome Assessment: The primary outcome was
measurement of LDL levels ≤100 mg/dL. The secondary
outcome was measurement of total cholesterol levels ≤200
mg/dL.
• Covariates: Gender, BMI, alcohol use in the past 12 months,
and cigarette smoking were adjusted for in the data analysis.
• Statistical Analysis: SPSS was used to conduct analysis.
Logistic regression was performed to obtain the Odds Ratios
(OR) of having elevated measured LDL and total cholesterol
levels after adjusting for other potential confounders and 95%
confidence intervals (CI). Results were considered statistically
significant if the p value fell below 0.05. Independent t-tests
were used to compare continuous variables. Chi square tests
were utilized to compare categorical variables.
Results
• When taking pravastatin or simvastatin, it is reasonable to expect
measurements of LDL-C and total cholesterol within normal ranges.
Comparative reductions to baseline differ from the different drug’s
potency and affinity for HMG-CoA reductase.
• Our study findings are consistent with previous trial data that
suggests superior efficacy of simvastatin regarding total cholesterol.
• Our results do not suggest statistically or clinically significant
differences in efficacy of pravastatin vs. simvastatin in terms of
achievement of normal LDL. In patients taking pravastatin, there
was a significant increase in the odds of having elevated total
cholesterol compared to simvastatin.
• Alcohol use had a significant impact on the efficacy of pravastatin
and simvastatin regarding measured LDL-C.
• Strength: baseline characteristics were similar amongst the
treatment groups
• Limitations: small sample size, unweighted NHANES data, unknown
duration of treatment with studied medications, unknown dose of
medications, lack of baseline LDL and total cholesterol data
• Further research conducted with a larger patient population is
required to assess the true comparative efficacy between
pravastatin and simvastatin.
Discussion/Conclusion
Table 1. Baseline Characteristics
Table 2. Comparison of LDL and Total Cholesterol Levels in
pravastatin vs. simvastatin
Table 3. Multivariable Logistic Regression Analysis of LDL
Outcomes Pravastatin,
N [%]
Simvastatin,
N [%]
P-value
LDL
Normal (≤100)
Elevated (≥101)
29 [50.9]
28 [49.1]
81 [62.8]
48 [37.2]
0.128
Total Cholesterol
Normal (≤200)
Elevated (≥201)
82 [67.8]
39 [32.2]
216 [82.8]
45 [17.2]
<0.001
Characteristics Pravastatin,
N [%]
Simvastatin,
N [%]
P-value
Total 137 287 -
Age
Mean [SD] 66.9 [9.72] 67.9 [11.03] 0.320
Gender
Male
Female
61 [44.5%]
76 [55.5%]
156 [54.4%]
131 [45.6%]
0.058
Race
Mexican American
Other Hispanic
Non-Hispanic White
Non-Hispanic Black
Non-Hispanic Asian
Other
16 [11.7%]
8 [5.8%]
60 [43.8%]
27 [19.7%]
19 [13.9%]
7 [5.1%]
34 [11.8%]
28 [9.6%]
124 [43.2%]
59 [20.6%]
32 [11.1%]
10 [3.4%]
0.716
BMI
Mean [SD]
BMI ≤ 24.9
BMI ≥ 25.0
30.66 [6.89]
23 [18.4]
102[81.6]
30.85 [7.03]
46 [17.2]
221 [82.8]
0.805
0.777
Alcohol use in last
12 mo.
73 [59.8%] 134 [52.1%] 0.160
Current Cigarette
Smoking
17 [12.4%] 38 [13.2%] 0.812
Characteristics Odds Ratio 95% CI P-value
Pravastatin vs.
simvastatin
1.539 [0.789 - 3.004] 0.206
Gender 1.527 [0.809 - 2.882] 0.192
BMI 1.374 [0.618 - 3.053] 0.435
Alcohol 2.281 [1.200 - 4.336] 0.012
Smoking 1.181 [0.530 - 2.630] 0.684
Characteristics Odds Ratio 95% CI P-value
Pravastatin vs.
simvastatin
2.307 [1.366 – 3.894] 0.002
Gender 2.218 [1.302 – 3.778] 0.003
BMI 1.026 [0.504 = 2.087] 0.944
Alcohol 1.594 [0.934 – 2.723] 0.088
Smoking 1.259 [0.601 – 2.637] 0.541
Table 4. Multivariable Logistic Regression Analysis of Total Cholesterol
References
1. Last AR, Ference JD, Menzel ER. Hyperlipidemia: Drugs for Cardiovascular Risk Reduction in Adults. Am Fam Physician.
2017 Jan 15;95(2):78-87.
2. Koch CG. Statin therapy. Curr Pharm Des. 2012;18(38):6284-90. doi: 10.2174/138161212803832335. PMID: 22762471.
3. Karr S. Epidemiology and management of hyperlipidemia. Am J Manag Care. 2017 Jun;23(9 Suppl):S139-S148.
4. Cholesterol: Types, tests, treatments, prevention. Cleveland Clinic. Available at: https://my.clevelandclinic.org/health/
articles/11920-cholesterol-numbers-what-do-they-mean. Accessed April 19, 2022.
5. Centers for Disease Control and Prevention (CDC). National Center for Health Statistics (NCHS). National Health and
Nutrition Examination Survey Data. Hyattsville, MD: U.S. Department of Health and Human Services, Centers for Disease
Control and Prevention, [2017-2018]. Available at: https://wwwn.cdc.gov/nchs/nhanes/continuousnhanes/default.aspx?
BeginYear=2017. Accessed April 19, 2022.
![Comparative efficacy of pravastatin versus simvastatin on LDL and total
cholesterol in patients with hypercholesterolemia
Lauryn Conti, Drew Hurley, Thomas Shugart, Jonathan Strandberg, Bekk Trojan
The University of Rhode Island, College of Pharmacy
Background
• Patients with hypercholesterolemia have been associated with a
two-fold increased risk for cardiovascular disease (CVD);
including potentially fatal stroke and myocardial infarction.
Statins lower LDL-C via inhibition of HMG-CoA reductase and are
associated with reduced cardiovascular morbidity and mortality1.
• Simvastatin has historically been more widely used due to its
high potency and efficacy. Although less potent, pravastatin is
correlated with less long-term kidney and muscle damage in
contrast with other statin medications2.
• Previous trials have found simvastatin to be superior to
pravastatin in lowering LDL-C and total cholesterol with
comparable tolerance[2,3].
Objectives
• The objective of this study was to evaluate the comparative
efficacy of pravastatin vs. simvastatin based on measured
LDL-C and total cholesterol values.
Methods
• Study Design/Data Source: A cross sectional analysis
was conducted using the National Health and Nutrition
Examination Survey (NHANES) 2017-2018 cycle dataset. The
data was unweighted.
• Exposure Definition: Participants reported use of pravastatin
or simvastatin in the 30 days prior to survey data collection.
• Outcome Assessment: The primary outcome was
measurement of LDL levels ≤100 mg/dL. The secondary
outcome was measurement of total cholesterol levels ≤200
mg/dL.
• Covariates: Gender, BMI, alcohol use in the past 12 months,
and cigarette smoking were adjusted for in the data analysis.
• Statistical Analysis: SPSS was used to conduct analysis.
Logistic regression was performed to obtain the Odds Ratios
(OR) of having elevated measured LDL and total cholesterol
levels after adjusting for other potential confounders and 95%
confidence intervals (CI). Results were considered statistically
significant if the p value fell below 0.05. Independent t-tests
were used to compare continuous variables. Chi square tests
were utilized to compare categorical variables.
Results
• When taking pravastatin or simvastatin, it is reasonable to expect
measurements of LDL-C and total cholesterol within normal ranges.
Comparative reductions to baseline differ from the different drug’s
potency and affinity for HMG-CoA reductase.
• Our study findings are consistent with previous trial data that
suggests superior efficacy of simvastatin regarding total cholesterol.
• Our results do not suggest statistically or clinically significant
differences in efficacy of pravastatin vs. simvastatin in terms of
achievement of normal LDL. In patients taking pravastatin, there
was a significant increase in the odds of having elevated total
cholesterol compared to simvastatin.
• Alcohol use had a significant impact on the efficacy of pravastatin
and simvastatin regarding measured LDL-C.
• Strength: baseline characteristics were similar amongst the
treatment groups
• Limitations: small sample size, unweighted NHANES data, unknown
duration of treatment with studied medications, unknown dose of
medications, lack of baseline LDL and total cholesterol data
• Further research conducted with a larger patient population is
required to assess the true comparative efficacy between
pravastatin and simvastatin.
Discussion/Conclusion
Table 1. Baseline Characteristics
Table 2. Comparison of LDL and Total Cholesterol Levels in
pravastatin vs. simvastatin
Table 3. Multivariable Logistic Regression Analysis of LDL
Outcomes Pravastatin,
N [%]
Simvastatin,
N [%]
P-value
LDL
Normal (≤100)
Elevated (≥101)
29 [50.9]
28 [49.1]
81 [62.8]
48 [37.2]
0.128
Total Cholesterol
Normal (≤200)
Elevated (≥201)
82 [67.8]
39 [32.2]
216 [82.8]
45 [17.2]
<0.001
Characteristics Pravastatin,
N [%]
Simvastatin,
N [%]
P-value
Total 137 287 -
Age
Mean [SD] 66.9 [9.72] 67.9 [11.03] 0.320
Gender
Male
Female
61 [44.5%]
76 [55.5%]
156 [54.4%]
131 [45.6%]
0.058
Race
Mexican American
Other Hispanic
Non-Hispanic White
Non-Hispanic Black
Non-Hispanic Asian
Other
16 [11.7%]
8 [5.8%]
60 [43.8%]
27 [19.7%]
19 [13.9%]
7 [5.1%]
34 [11.8%]
28 [9.6%]
124 [43.2%]
59 [20.6%]
32 [11.1%]
10 [3.4%]
0.716
BMI
Mean [SD]
BMI ≤ 24.9
BMI ≥ 25.0
30.66 [6.89]
23 [18.4]
102[81.6]
30.85 [7.03]
46 [17.2]
221 [82.8]
0.805
0.777
Alcohol use in last
12 mo.
73 [59.8%] 134 [52.1%] 0.160
Current Cigarette
Smoking
17 [12.4%] 38 [13.2%] 0.812
Characteristics Odds Ratio 95% CI P-value
Pravastatin vs.
simvastatin
1.539 [0.789 - 3.004] 0.206
Gender 1.527 [0.809 - 2.882] 0.192
BMI 1.374 [0.618 - 3.053] 0.435
Alcohol 2.281 [1.200 - 4.336] 0.012
Smoking 1.181 [0.530 - 2.630] 0.684
Characteristics Odds Ratio 95% CI P-value
Pravastatin vs.
simvastatin
2.307 [1.366 – 3.894] 0.002
Gender 2.218 [1.302 – 3.778] 0.003
BMI 1.026 [0.504 = 2.087] 0.944
Alcohol 1.594 [0.934 – 2.723] 0.088
Smoking 1.259 [0.601 – 2.637] 0.541
Table 4. Multivariable Logistic Regression Analysis of Total Cholesterol
References
1. Last AR, Ference JD, Menzel ER. Hyperlipidemia: Drugs for Cardiovascular Risk Reduction in Adults. Am Fam Physician.
2017 Jan 15;95(2):78-87.
2. Koch CG. Statin therapy. Curr Pharm Des. 2012;18(38):6284-90. doi: 10.2174/138161212803832335. PMID: 22762471.
3. Karr S. Epidemiology and management of hyperlipidemia. Am J Manag Care. 2017 Jun;23(9 Suppl):S139-S148.
4. Cholesterol: Types, tests, treatments, prevention. Cleveland Clinic. Available at: https://my.clevelandclinic.org/health/
articles/11920-cholesterol-numbers-what-do-they-mean. Accessed April 19, 2022.
5. Centers for Disease Control and Prevention (CDC). National Center for Health Statistics (NCHS). National Health and
Nutrition Examination Survey Data. Hyattsville, MD: U.S. Department of Health and Human Services, Centers for Disease
Control and Prevention, [2017-2018]. Available at: https://wwwn.cdc.gov/nchs/nhanes/continuousnhanes/default.aspx?
BeginYear=2017. Accessed April 19, 2022.](https://image.slidesharecdn.com/posterproject-220523195111-8413af16/85/Comparative-Efficacy-of-Simvastatin-vs-Pravastatin-in-Primary-Endpoints-of-Hypercholesterolemia-Poster-Project-pdf-1-320.jpg)
