Rosuvastatin versus atorvastatin
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Comparative Efficacy of Rosuvastatin and Atorvastatin
Regression of Coronary Atherosclerotic Plaques
Rosuvastatin has been shown to be more effective than atorvastatin in reducing coronary atherosclerotic plaques. A meta-analysis of five randomized controlled trials with 1,556 participants demonstrated that rosuvastatin significantly reduced total atheroma volume and percent atheroma volume more than atorvastatin. Additionally, rosuvastatin improved lumen volume more significantly.
Lipid Profile Improvement in Hypercholesterolemia
In patients with type IIa or IIb hypercholesterolemia, rosuvastatin was found to be more effective than atorvastatin in reducing low-density lipoprotein (LDL) cholesterol and increasing high-density lipoprotein (HDL) cholesterol. Rosuvastatin 5 mg and 10 mg resulted in greater reductions in LDL cholesterol and greater increases in HDL cholesterol compared to atorvastatin 10 mg. Similarly, the STELLAR trial showed that rosuvastatin reduced LDL cholesterol more significantly across various doses compared to atorvastatin, simvastatin, and pravastatin.
Impact on Inflammatory Biomarkers and LV Function in Diabetic Patients
In type 2 diabetic patients with dyslipidemia, rosuvastatin was more effective than atorvastatin in improving lipid profiles, reducing inflammatory biomarkers, and enhancing left ventricular function. Rosuvastatin led to greater reductions in HbA1c, LDL-C, triglycerides, total cholesterol, atherogenic index, hs-CRP, sortilin, and leptin, while increasing adiponectin and HDL-C more significantly than atorvastatin.
Long-Term Efficacy and Safety in Coronary Artery Disease
A long-term study comparing rosuvastatin and atorvastatin in adults with coronary artery disease found that both statins had comparable efficacy for the composite outcome of all-cause death, myocardial infarction, stroke, or any coronary revascularization over three years. However, rosuvastatin was associated with lower LDL cholesterol levels but a higher risk of new-onset diabetes mellitus and cataract surgery compared to atorvastatin.
Renal Effects in Diabetic Patients with Progressive Renal Disease
In patients with diabetes and proteinuria, atorvastatin showed more renoprotective effects compared to rosuvastatin, despite rosuvastatin's greater efficacy in lowering plasma lipid concentrations. Atorvastatin significantly lowered the urine protein:creatinine ratio more than rosuvastatin.
Efficacy in Familial Hypercholesterolemia
In patients with heterozygous familial hypercholesterolemia, rosuvastatin was more effective than atorvastatin in reducing LDL cholesterol and improving HDL cholesterol. Rosuvastatin also enabled more patients to achieve LDL cholesterol goals compared to atorvastatin.
High-Risk Hypercholesterolemia Patients
The POLARIS study found that rosuvastatin 40 mg was more effective than atorvastatin 80 mg in reducing LDL cholesterol and achieving LDL cholesterol goals in high-risk patients with hypercholesterolemia. Rosuvastatin also resulted in greater increases in HDL cholesterol and apolipoprotein A-I levels.
Conclusion
Overall, rosuvastatin generally demonstrates superior efficacy in reducing LDL cholesterol, improving HDL cholesterol, and regressing coronary atherosclerotic plaques compared to atorvastatin. However, it is associated with a higher risk of new-onset diabetes mellitus and cataract surgery. The choice between these statins should consider individual patient profiles and specific clinical goals.
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