Thesis (M.Sc.)--Chulalongkorn University, 2008

To compare the effectiveness of atorvastatin, rosuvastatin, and simvastatin among CHD/CHD risk equivalent patients in usual clinical practice. A Cross-sectional retrospective study was conducted by using electronic database among patients who were newly prescribed statin therapy during October 2004 to September 2007 and didn’t receive dyslipidemic drugs in the preceding 6 months. Patients aged 35 years or older with CHD/CHD-risk equivalent and LDL-C baseline > 100 mg/dL were included. Patients must receive statins not less than 90 days. Outcome measurements were the percentage of patients who achieved LDL-C goal according to NCEP ATP III guideline and mean of percent change in LDL C – reduction including economic assessment for drug costs only. Chi-square test and ANOVA were used for statistic analysis. Of the 1,024 patients who met the study criteria, 794 taking simvastatin, 109 taking atorvastatin and 121 taking rosuvastatin. Patients had average age of 62 years and 47.9% were male. The results showed that lipid goal achievement based on NCEP ATP III goal of LDL-C <100 mg/dL of rosuvastatin (78%), simvastatin (68%), and atorvastatin (62.4%) were not statistically different (P=0.078). The mean of percent change in LDL-C reduction of rosuvastatin was the greatest compared with simvastatin and atorvastatin significantly (-46.1%, -38.5%, and -38.2%, P<0.05). Simvastatin was the most cost-effectiveness compared with rosuvastatin and atorvastatin (376, 16,670, and 29,417 Baht per patient at goal per year). In conclusion, simvastatin is the most cost -effectiveness in achieving LDL-C goals according to NCEP ATP III guideline compared with rosuvastatin and atorvastatin among CHD/CHD-risk equivalent patients. Therefore, simvastatin should be the first choice for CHD/CHD-risk equivalent patients except the patients who has contra-indication with simvastatin