Users' Guides to the Medical Literature
Guyatt G, Rennie D, Meade MO, Cook DJ
Part G Moving from Evidence to Action
Chapter 22.5. Drug Class Effects
Regina Kunz, Heiner C. Bucher, Finlay A. McAlister, Anne Holbrook, Gordon Guyatt
Clinical Scenario
Topics Discussed:
atherosclerosis, drug class effects, statins
Excerpt:
"As a busy primary care clinician, you care for many patients
with elevated serum cholesterol levels and others with normal cholesterol
levels but established atherosclerotic vascular disease, in whom
statins (hydroxymethylglutaryl–coenzyme A reductase inhibitors)
lower the risk of atherosclerotic vascular events. A speaker
at a recent continuing medical education conference reviewed the
benefits of cholesterol-lowering therapy, stressed the importance
of maximal low-density lipoprotein (LDL) lowering, and commented
in favor of the most potent drug. Although you approve of using
statin therapy for patients with elevated cholesterol levels and
for those who have "normal" lipid levels but have
known atherosclerosis, you are uncertain about which of the 6 statins
currently available is the best. You ask a local cardiologist and
endocrinologist; one suggests pravastatin, and the other, rosuvastatin.
They raise a variety of issues: efficacy in different patient populations,
demonstrated benefit in randomized controlled
trials (RCTs) (part of the case for
pravastatin), maximal LDL lowering (the major argument for rosuvastatin,
which has not been tested in RCTs to determine its effect
on patient-important outcomes), safety profile, drug interactions,
and pricing. Faced with competing claims, you realize that you need
a framework for making your statin selection...."
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