Rosuvastatin and atorvastatin were comparable in terms of all-cause death, coronary revascularization, myocardial infarction, or stroke at 3 years of intervention in a randomized prospective trial. However, rosuvastatin administration was related to comparatively lower levels of low-density lipoprotein cholesterol and a higher risk for cataract surgery and antidiabetic treatment.
Statins are known to be effective in reducing the levels of low-density lipoprotein cholesterol (LDL-C) and the associated risk of cardiovascular events. The adverse effects, more specific to high-potency drugs, include muscle symptoms, altered glucose homeostasis, and impaired renal and liver function. However, there is considerable uncertainty regarding the relationship between these adverse effects and the drug class or the individual drug.
In the LODESTAR randomized prospective trial, the authors addressed this gap by comparing the safety and efficacy of rosuvastatin and atorvastatin in treating coronary artery disease (CAD) patients. The study findings are published in the British Medical Journal.
Baseline Characteristics
Of the total study participants, 2204 and 2196 participants were randomized to the rosuvastatin and atorvastatin groups, respectively. The mean age of the study participants was 65 ± 10 years, and 27.9% of the participants were female. The baseline characteristics of the rosuvastatin and atorvastatin groups were comparable.
Drug Dosage and Utilization in Rosuvastatin and Atorvastatin GroupsF
The use of high-intensity statin was significantly lower in the rosuvastatin and atorvastatin groups at 2 years (p = 0.04) and 3 years (p = 0.02) of treatment. At 3 years, the mean daily dose of the drug in the rosuvastatin and atorvastatin groups was 17.1 ± 5.2 mg and 36.0 ± 12.8 mg, respectively. Rosuvastatin group participants reported significantly lower utilization of ezetimibe compared to the atorvastatin group at 3 months (p < 0.05).
Clinical Efficacy of Rosuvastatin vs. Atorvastatin
Of the total participants, 98.7% completed the clinical follow-up period of 3 years. The primary endpoint (death, coronary revascularization, myocardial infarction, or stroke) occurred in 8.7% and 8.2% of the participants in the rosuvastatin and atorvastatin groups, respectively. There were no significant differences across the two groups for all-cause death (p = 0.57), myocardial infarction (p = 0.37), stroke (p = 0.55), and coronary revascularization (p = 0.81).
The mean levels of LDL-C were significantly different between the rosuvastatin and atorvastatin groups (1.8 ± 0.5 mmol/L vs. 1.9 ± 0.5 mmol/L; p < 0.001). The study findings indicated a significantly higher proportion of participants in the rosuvastatin group who demonstrated LDL-C levels less than 1.8 mmol/L at 6 weeks (p < 0.001), 3 months (p = 0.02), 6 months (p < 0.001), 1 year (p < 0.001), 2 years (p < 0.001), and 3 years (p < 0.001).
Safety of Rosuvastatin vs. Atorvastatin
The incidence of new-onset diabetes mellitus requiring initiation of antidiabetic treatment and cataract surgery was significantly greater in the rosuvastatin group compared to the atorvastatin group.
Source:
Lee, Y., Hong, S. J., Kang, W. C., Hong, B., Lee, J., Lee, J., Cho, H., Yoon, J. H., Lee, S., Ahn, C., Kim, J. S., Kim, B., Ko, Y. G., Choi, D., Jang, Y., & Hong, M. K. (2023). Rosuvastatin versus atorvastatin treatment in adults with coronary artery disease: secondary analysis of the randomised LODESTAR trial. The BMJ, e075837. https://doi.org/10.1136/bmj-2023-075837
