The VOYAGER (indiVidual patient data meta-analysis Of statin therapY in At-risk Groups: Effects of Rosuvastatin, atorvastatin and simvastatin) database is derived from 37 rosuvastatin studies that examined rosuvastatin, atorvastatin, or simvastatin

ApoB levels were compared with those of LDL-C

and non-HDL-C, both at baseline and on therapy, and the relation of apoB levels to LDL-C and non-HDL-C levels was modeled using linear regression

The first study compared lipid goals in diabetic and nondiabetic patients among 12,269 identified at high risk of CHD, 5156 of whom had type 2 diabetes mellitus and 7113 were nondiabetic

  Target apoB = 90 mg/dL

Target apoB = 80 mg/dL

Baseline LDL-C (mg/dL)

On-therapy LDL-C

(mg/dL)

Baseline LDL-C

(mg/dL)

On-therapy LDL-C

(mg/dL)Diabetes Diabetes (n = (n = 5156)5156)

115.0* 82.5** 107.2* 72.8**

No No diabetes diabetes (n = (n = 7113)7113)

106.4* 80.4** 97.4* 70.1**

All All patients patients (n = (n = 12,269)12,269)

110.3* 81.4** 101.8* 71.4**

Linear Regression of LDL-C vs ApoB:

Diabetes vs No Diabetes

*R2 = 0.61-0.66**R2 = 0.77-0.81

The second study using data from the VOYAGER database examined the effect of race and ethnicity on the relationship between apoB and LDL-C or non-HDL-C.

Cholesterol levels were measured at baseline and during statin therapy in 10,046 white, 665 black, 658 Asian, and 873 Hispanic/Latino patients at high risk of CHD.

Analysis of the VOYAGER data showed that at baseline, LDL-C and non-HDL-C correlated "reasonably well" with apoB in all groups, with the lowest concentrations observed in Asians and the highest in blacks.

On statin therapy, to reach an apoB of 90 mg/dL, blacks required an LDL-C of 87.2 mg/dL, while Hispanics required an LDL-C of 78.3 mg/dL.

High-High-Risk Risk Race/EthRace/Ethnic nic GroupGroup

Target apoB = 90 mg/dL

Target apoB = 80 mg/dL

Baseline LDL-C (mg/dL)

On-therapy LDL-C

(mg/dL)

Baseline LDL-C

(mg/dL)

On-therapy LDL-C

(mg/dL)

White White (n = (n = 10,046)10,046)

110.6* 81.2† 102.1* 71.3†

Hispanic/Hispanic/LatinoLatino (n = (n = 873)873)

108.6* 78.3† 100.8* 76.1†

Asian Asian (n = 685)(n = 685)

108.5** 82.1‡ 100.0** 72.7‡

BlackBlack (n = (n = 665)665)

114.4* 87.2† 105.5* 68.4†

Linear Regression of LDL-C vs ApoB by Race/Ethnicity

*R2 = 0.60-0.65**R2 = 0.48†R2 = 0.79-0.84‡R2 = 0.68

An apoB of 90 mg/dL corresponded to an LDL-C of 114.4 mg/dL for blacks and 108.5 mg/dL for Asians and Hispanics ( Table ).

The relationship between statin-induced increases in concentration of highdensity lipoprotein cholesterol (HDL-C) and statin-induced decreases in concentration of low-density lipoprotein cholesterol (LDL-C) is unknown.

In this study we investigate the HDL-C raising effects of individual statins across their dose ranges and relate them to the corresponding reductions in LDL-C.

The effects of different statins on HDL-C levels and the relationships between changes in HDL-C and changes in LDL-C have been investigated in an individual patient meta-analysis of 33,841 dyslipidemic patients included in 37 randomized studies using rosuvastatin (RSV), atorvastatin (ATV) and simvastatin (SIM).

HDL-C increased in a dose dependent fashion with RSV and SIM but not with ATV where the increase was less at higher doses.

A subgroup analysis of 9,297 diabetic patients revealed consistently smaller increases in HDL-C at all doses of all statins.

There was no apparent relationship between the reduction in LDL-C and the increase in HDL-C, whether analyzed overall for all statins (Spearman’s rank correlation coefficient=0.005) or for each statin individually.

Increases in HDL-C were positively related to statin dose with Rosuvastatin and Simvastatin but inversely related to dose with Atorvastatin

The magnitude of statin-induced increases in HDL-C is unrelated to the magnitude of the decrease in LDL-C.

VOYAGER VOYAGER new meta-new meta-analysisanalysis

The present study has used the existing VOYAGER database

The following were assessed in each of the 4 statin benefit groups identified by the 2013 ACC/AHA guidelines:The extent of LDL-C lowering & Percentage of patients achieving

50% LDL-C reduction

Lipid lowering was compared for Rosuvastatin 20/40 mg and Atorvastatin 40/80 mg

The 4 statin benefit groups, as per 2013 ACC/AHA guidelines, are as follows: ASCVD Baseline LDL-C 190 mg/dL Diabetes 10-year ASCVD risk 7.5% (no known ASCVD or

diabetes

LSM reductions in LDL-C were numerically greater with rosuvastatin 20 and 40 mg, compared with atorvastatin 40 mg

Rosuvastatin 20 mg produced numerically similar reductions in LDL-C to atorvastatin 80 mg

These changes were overall and also in the four individual statin benefit groups

Percentage of patients achieving >50% reduction in LDL-C varied with the choice and dose of statin

Rosuvastatin 40 mg consistently achieved 50% reductions of LDL-C overall and in each of the four defined statin benefit groups

A higher number of patients achieved >50% reduction i.e. 71 to 80% of total patients

The Cholesterol Treatment Trialists' Collaborators (CTTC) meta-analysis has already given evidence that:

The choice and dose of statin have an impact both on percent LDL-C reduction and on achievement of a >50% reduction of LDL-C, overall and within each of the four statin benefit groups

This information may be of importance for clinicians in their choice of statin for individual patients