Issue 167 Item 12 FDA Soon To Approve New “Super Statin” Crestor (rosuvastatin)

The Introductiuon of Crestor will trigger another round of marketing wars and questions about which statin is best. Watch for a lot of claims. Find out the facts, which statin are best.

FDA Soon To Approve New "Super StaThe Introductiuon of Crestor will trigger another round of marketing wars and questions about which statin is best. Watch for a lot of claims. Find out the facts, which statin are best.tin" Crestor (rosuvastatin)Potency. Crestor, Lipitor, and Zocor are the most effective for lowering LDL…Crestor works best for raising HDL. Crestor 10 mg lowers LDL about 50%. It’s at least as effective as Lipitor 20 mg or Zocor 80 mg.

Liver function tests. Testing recommendations vary…but the risk of increased liver enzymes is similar with all the statins.

Hepatotoxicity is rare, if it occurs at all. Myopathy. The risk is similar for all statins…and increases with higher doses or when combined with gemfibrozil.

Renal monitoring. Crestor is the only statin associated with kidney problems. Patients might need to be monitored for proteinuria if they’re taking the highest dose… 40 mg/day.

Drug interactions. Interactions are most likely with Zocor…Mevacor…and to a lesser extent, Lipitor.

These statins are metabolized by CYP3A4 and can interact with 3A4 inhibitors…ketoconazole, erythromycin, grapefruit juice, etc.. Interactions are less likely with Pravachol, or Crestor. Which are not significantly metabolized by cytochrome P450 and may be less likely to be involved in drug interactions.

Clinical benefit. So far Zocor and Pravachol have the best evidence for improved outcomes. But there’s growing evidence that the others are beneficial too.

Crestor at its highest does of 40mg, can reduce LDL cholesterol 62% (Must monitor renal function with the 40 mg dose). The next best is Lipitor 80mg which, reduced LDL by 54%. There’s no proof yet that Crestor improves outcomes…but studies will be available shortly.