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The aim of this study is to compare the efficacy and safety of pitavastatin and atorvastatin using data from randomized-controlled trial pooled together by means of a meta-analysis and decide which is better.PubMed, CENTRAL, Web of Knowledge, and ClinicalTrials.gov website were searched for randomized-controlled trials published until October 2016. Eligible studies comparing pitavastatin with atorvastatin head to head and reporting the outcome of low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), glycated hemoglobin, and intravascular ultrasound evaluation were enrolled. Heterogeneity was assessed by using the I2 statistic, and the extracted data were estimated by fixed-effects model.Eleven trials including a total number of 1733 participants were identified. Compared with atorvastatin, changes in the mean differences of LDL-C and HDL-C were 2.51 [95% confidence interval (CI): 1.17–3.86; I2=48%; P=0.0003] and 2.17 (95% CI: 1.42–2.91; I2=40%; P<0.00001), respectively, for pitavastatin. The changes in the mean differences of glycated hemoglobin was −0.15 (95% CI: −1.44–1.15; I2=0%; P=0.83) for pitavastatin compared with atorvastatin. For plaque volume, lumen volume, and external elastic membrane, the changes are −0.93 (95% CI: −3.04–1.19; I2=50%; P=0.39), 0.17 (95% CI: −2.91–3.26; I2=0%; P=0.91), and −0.43 (95% CI: −1.96–1.11; I2=4%; P=0.58), respectively, for pitavastatin versus atorvastatin.In this study, pitavastatin seems to be less effective in reducing LDL-C and elevating HDL-C level compared with atorvastatin. Moreover, there is no significant difference in changes of glycated hemoglobin and intravascular ultrasound evaluation between pitavastatin and atorvastatin.