Searching the place of pitavastatin in the current treatment of patients with dyslipidemia

Abstract

Pitavastatin is the last marketed statin. Different studies have shown that pitavastatin is more potent than pravastatin and simvastatin in reducing LDL-cholesterol levels, and equivalent to atorvastatin and rosuvastatin. Moreover, pitavastatin provides a significant and sustained increase of HDL-cholesterol levels. Remarkably, as pitavastatin is minimally metabolized by CYP, the risk of interactions with other drugs is low. Additionally, pitavastatin does not interfere with glucose metabolism in diabetics and non-diabetics, and exerts a beneficial effect in patients with renal dysfunction. However, although available information may suggest that pitavastatin can improve cardiovascular prognosis, data coming from specifically designed clinical trials are still warranted. The aim of this review was to update the available evidence about efficacy and safety of pitavastatin, and to analyze the place of pitavastatin in the current armamentarium for the treatment of patients with hypercholesterolemia.

Keywords::

• atorvastatin
• HDL-cholesterol
• hypercholesterolemia
• interactions
• LDL-cholesterol
• pitavastatin
• rosuvastatin
• statin
• treatment

Financial & competing interests disclosure

V Barrios has received honoraría for lectures from AstraZeneca, Pfizer, MSD and Recordati and consulting fees from AstraZeneca and Recordati. C Escobar has received honoraria for lectures from AstraZeneca, MSD and Recordati. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Key issues

• • Despite the current therapeutic armamentarium, many patients do not achieve recommended low-density lipoprotein (LDL)-cholesterol goals.

• • Pitavastatin, the last marketed statin, is similarly effective as the other potent statins, including atorvastatin and rosuvastatin, in reducing LDL-cholesterol levels.

• • Moreover, pitavastatin provides a sustained increase of high-density lipoprotein (HDL)-cholesterol levels.

• • In contrast to other statins, pitavastatin does not interfere with glucose metabolism in diabetics or in non-diabetics.

• • Different studies have suggested that in patients with renal dysfunction, pitavastatin may increase estimated glomerular filtration rate (eGFR) and reduce microalbuminuria.

• • Pitavastatin is minimally metabolized by cytochrome P450 (CYP). As a result, the risk of interactions with other drugs is lower compared with other statins, what is an important advantage in polymedicated patients.

• • However, although the available information suggests that pitavastatin may improve cardiovascular prognosis, data from outcomes clinical trials specifically designed are required. Fortunately, studies such as REAL-CAD or DIALYSIS will soon answer this question.

Notes

eGFR: Estimated glomerular filtration rate; HDL: High-density lipoprotein; LDL: Low-density lipoprotein; L-FABP: Liver-type fatty-acid-binding protein.