Alternate day versus daily atorvastatin in low-density lipoprotein cholesterol reduction: A meta-analysis

Statins are the mainstay treatment for hyperlipidemia. They are hydroxymethylglutaryl-CoA inhibitors and cause reduction in low-density lipoprotein cholesterol (LDL-c) levels. Atorvastatin is one of the most commonly used statins. These drugs are usually prescribed in a daily dose regimen. Due to the long duration of action and prolonged effect on hepatocytes, alternate day atorvastatin therapy is theoretically as effective as daily dose atorvastatin. Several studies have compared the efficacy of alternate day and daily atorvastatin in LDL-c reduction. The authors performed a metaanalysis on these studies to find evidence for alternate day atorvastatin use in LDL-c reduction. The studies comparing alternate day and daily atorvastatin regimens were selected after a literature search. LDL-c reduction in both the alternate and daily groups were calculated from the data provided in the individual studies. The mean difference in LDL-c reduction was compared between the alternate day and daily atorvastatin groups. Metaanalysis performed on the studies revealed that the mean difference in LDL-c reduction among the alternate day and daily groups was only 8.36 mg/dL (95% CI −0.49 to 17.20). This difference was statistically not significant but trends toward a daily regimen. Further subgroup analysis suggested that the difference in LDL-c reduction is smaller in an atorvastatin-naive patient population (mean difference 0.92 mg/dL [95% CI −13.55 to 15.39 mg/dL]) and also in populations with fewer risk factors for cardiovascular disease (mean difference 3.79 mg/dL (95% CI −6.40 to 13.98 mg/dL]). In conclusion, the use of alternate day atorvastatin can reduce the cost by one-half and possibly offset many of its side effects. However, long-term studies with large sample sizes are required to evaluate its effect on cardiovascular events and mortality.