Pravastatin versus rosuvastatin
Pro Research Analysisby 
Searched over 200M research papers
Consensus Meter
Comparative Analysis of Pravastatin and Rosuvastatin
Efficacy in Lowering LDL Cholesterol
Rosuvastatin Superior in LDL Reduction
Rosuvastatin has been consistently shown to be more effective than pravastatin in reducing low-density lipoprotein cholesterol (LDL-C). In a 6-week trial, rosuvastatin reduced LDL-C by 26% more than pravastatin across various doses. Another study over 52 weeks found that rosuvastatin at both 5 mg and 10 mg doses significantly outperformed pravastatin 20 mg in lowering LDL-C levels. Additionally, in HIV-1-infected patients, rosuvastatin 10 mg/day was more effective than pravastatin 40 mg/day, achieving a 37% reduction in LDL-C compared to 19% with pravastatin.
Achievement of Cholesterol Goals
Higher Goal Achievement with Rosuvastatin
Rosuvastatin also demonstrated superior performance in helping patients achieve cholesterol goals set by the National Cholesterol Education Program (NCEP) and European guidelines. In pooled analyses, 86% of patients treated with rosuvastatin 10 mg achieved NCEP goals compared to 49% of those treated with pravastatin 20 mg. Similarly, in the STELLAR trial, a higher percentage of patients on rosuvastatin achieved LDL-C levels <100 mg/dL compared to those on pravastatin.
Metabolic Effects
Differential Metabolic Impact
While rosuvastatin is more potent in lipid reduction, it has been associated with some adverse metabolic effects. Rosuvastatin therapy increased fasting insulin and HbA1c levels while decreasing plasma adiponectin and insulin sensitivity, which are markers of insulin resistance. In contrast, pravastatin therapy showed beneficial effects by decreasing fasting insulin and HbA1c levels and increasing plasma adiponectin and insulin sensitivity.
Safety and Tolerability
Comparable Safety Profiles
Both rosuvastatin and pravastatin were generally well-tolerated across studies. In the STELLAR trial, drug tolerability was similar across all treatments, including rosuvastatin and pravastatin. In HIV-1-infected patients, no severe adverse events were attributed to either statin, and there were no significant renal, hepatic, or muscular events reported.
Effects on Lipid Ratios and Atherogenic Profiles
Rosuvastatin's Superior Impact on Lipid Ratios
Rosuvastatin has shown greater efficacy in improving lipid ratios, which are strong predictors of coronary artery disease (CAD). In pooled analyses, rosuvastatin significantly reduced ratios such as LDL-C/HDL-C and apo B/apo A-I more than pravastatin. Additionally, rosuvastatin was more effective in normalizing LDL size and subfraction distributions, leading to a less atherogenic phenotype in HIV-1 patients.
Conclusion
In summary, rosuvastatin is more effective than pravastatin in reducing LDL-C and achieving cholesterol goals. However, it may have adverse metabolic effects that are not observed with pravastatin. Both statins have comparable safety profiles, but rosuvastatin offers superior improvements in lipid ratios and atherogenic profiles. These findings suggest that while rosuvastatin is a potent option for lipid reduction, its metabolic effects should be considered, especially in patients prone to metabolic diseases.
Sources and full results
Most relevant research papers on this topic