OBJECTIVES: The aim of this study was to conduct a meta-analysis of randomized clinical trials (RCTs) to identify the effectiveness and safety of atorvastatina (20mg-80mg) against pravastatin, simvastatin and rosuvastatin. METHODS: A systematic review was performed including RCTs in primary and secondary prevention where total cholesterol, LDL-C, HDL-C, major cardiovascular events, as well as adverse events frequency werw analyzed. RCTs were searched in March 2009 in Medline, EMBASE and the Cochrane Collaboration. Two independent reviewers identified the abstracts, selected the full articles, and extracted the data. Odds ratios (OR) and weighted means differences were calculated with 95% confidence intervals (95%CI). Random effects models were employed in the Meta-analyses using RevMan v.5.0 software. RESULTS: From 7539 studies, 66 RCT were selected. Atorvastatin showed statistically a higher improvements in LDL-C, total cholesterol, HDL-C and triglycerides in comparison to pravastatin and simvastatin (5%-15%). Rosuvastatin was statistically superior against atorvastatin in LDL-C and total cholesterol, however not in HDL-C and triglycerides (p<0.01). Atorvastatin obtained higher reductions in acute myocardial infarctions (AMI), unstable angina, and revascularizations in comparison to pravastatin and simvastatin (p<0.05). Atorvastatin 80mg showed in comparison to pravastatin 40mg a higher reduction of mayor cardiovascular events (OR 0.87; 95%CI 0.77-0.97, p = 0.01), revascularization (OR 0.86; IC95% 0.76-0.98, p = 0.02) and unstable angina (OR 0.74; 95%CI 0.57-0.95, p = 0.02); nevertheless no statistical differences were found for AMI or cardiovascular death. Rosuvastatin requires data on cardiovascular events prevention in order to be compare appropriately against atorvastatin. The frequency of adverse events resulted similar among all the statins considered in the assessment. CONCLUSIONS: Atorvastatin in comparison to pravastatin and simvastatin showed a higher control of dyslipidemia and a better reduction of major cardiovascular events, without increasing the frequency of adverse events.