Issue 144 Item 10 Rosuvastatin Reduces LDL Cholesterol and Improves Lipid Profil

Rosuvastatin (Crestor; AstraZeneca) is more effective than atorvastatin (Lipitor; Pfizer, Inc.) All across dose ranges in reducing low-density lipoprotein (LDL) cholesterol and improving lipid profiles, rosuvastatin was more effective in patients with hypercholesterolemia. That, according to a report in the January 1st issue of the American Journal of Cardiology.

However, significantly lower triglyceride levels were achieved with atorvastatin 80 mg compared with rosuvastatin.

This study represents the "first prospective investigation to directly compare the lipid-altering effects of these two statins at fixed levels across the entire range of dosages for each drug in patients with hypercholesterolemia and without active arterial disease," Dr. Dennis W. Schneck, of AstraZeneca, Wilmington, Delaware, and colleagues write.

In this 6-week, randomized, double-blind study, the patients had baseline LDL cholesterol of at least 160 mg/dL but less than 250 mg/dL and fasting triglycerides less than 400 mg/dL. Two hundred nine patients received once-daily rosuvastatin (5, 10, 20, 40, or 80 mg) and 165 patients received once-daily atorvastatin (10, 20, 40, or 80 mg).

Rosuvastatin produced greater dose-dependent decreases in LDL cholesterol (ranging from -46.6% at 10 mg to -61.9% at 80 mg) than did atorvastatin (-38.2% at 10 mg to -53.5% at 80 mg). Compared with atorvastatin, rosuvastatin produced a mean 8.4% greater decrease from baseline in LDL cholesterol (p < 0.001).

Rosuvastatin also produced greater mean decreases in total cholesterol (4.9%, p < 0.001), non-HDL cholesterol (7.0%, p < 0.001), and apolipoprotein B (6.3%, p < 0.001) across dosage ranges. Compared with atorvastatin, rosuvastatin produced significant decreases in all lipoprotein ratios (p < 0.001).

"Because dose responses for HDL cholesterol, triglycerides, and apolipoprotein A-1 were non-log-linear and nonparallel between the two drugs, percentage changes from baseline were compared at each dose," Dr. Schneck and colleagues explain.

The team notes that 80 mg atorvastatin produced significantly greater decreases in triglycerides compared with 80 mg rosuvastatin.

Both drugs were well tolerated over 6 weeks. "Clinically relevant increases in hepatic transaminases or creatine kinase, indicative of hepatotoxicity or myotoxicity, were not observed with either trial medication," they add. Am J Cardiol 2003;91:33-41