Abstract 16435: Dose-Dependent Lipid Effects and Safety of Pitavastatin versus Other Statins in Dyslipidemia: A Systematic Review and Network Meta-Analysis

Abstract

Background: Dyslipidemia is a major contributor to cardiovascular morbidity and mortality, making optimized statin therapy essential for lipid management. Although pitavastatin has demonstrated favorable effects on lipid parameters and tolerability, its dose-dependent efficacy and safety compared with commonly prescribed statins including atorvastatin, rosuvastatin, simvastatin, and pravastatin remain incompletely characterized. We performed a systematic review and network meta-analysis to compare and rank pitavastatin doses (1 mg, 2 mg, and 4 mg) and other statin regimens for LDL-C, total cholesterol (TC), HDL-C, triglycerides (TG), and adverse-event outcomes. Methods: PubMed, Embase, Scopus, and Cochrane CENTRAL were systematically searched through May 20, 2026. A random-effects network meta-analysis was performed in R (version 4.5.1) to evaluate percentage changes in low-density lipoprotein cholesterol (LDL-C), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), and triglycerides (TG). Safety outcomes were assessed using adverse events (AEs). Treatment rankings were determined using P-scores. Effect estimates were reported as mean differences (MDs) or risk ratios (RRs) with 95% confidence intervals (CIs), with pitavastatin 2 mg used as the reference comparator for network estimates. Results: A total of 19 studies comprising 32,907 patients were included. For LDL-C reduction, rosuvastatin 10 mg ranked highest (P-score 0.9906), followed by rosuvastatin 5 mg (P-score 0.8181). Pitavastatin 4 mg demonstrated significant LDL-C reduction compared with pitavastatin 2 mg (MD -5.78; 95% CI -7.78 to -3.77; P-score 0.7700). For TC reduction, atorvastatin 20 mg (MD -10.66; P-score 0.9674) and rosuvastatin 5 mg (MD -9.18; P-score 0.9147) outperformed pitavastatin 4 mg (MD -5.23; P-score 0.7501).Pitavastatin 4 mg ranked highest for HDL-C elevation (P-score 0.8806; MD 1.27 vs pitavastatin 2 mg) and triglyceride reduction (P-score 0.9567; MD -6.09; 95% CI -8.24 to -3.95), followed by atorvastatin 20 mg for TG reduction (P-score 0.8546). In safety analyses, pitavastatin 4 mg demonstrated one of the most favorable adverse-event profiles (P-score 0.7953; RR 0.77 vs pitavastatin 2 mg), whereas simvastatin 20 mg was associated with the highest risk of adverse events (RR 3.06; P-score 0.2862). Conclusion: Pitavastatin 4 mg ranked highest for HDL-C elevation, triglyceride reduction, and safety rankings, whereas rosuvastatin and atorvastatin demonstrated greater LDL-C and TC lowering. These findings suggest that pitavastatin may represent an effective dose-dependent alternative for patients requiring comprehensive lipid optimization and favorable tolerability profiles, particularly in the setting of elevated triglycerides and low HDL-C.