Statins Effectively Lower Cholesterol, But Experts Debate First Choice

March 15, 2004

March 15, 2004 (New Orleans) ---- study coming out of this year's American College of Cardiology 53rd annual scientific session shows that rosuvastatin is significantly more effective than other statins at lowering cholesterol levels. However, some experts are reserving final judgment until more data are available.

Prakash Deedwania, MD, from the University of California at San Francisco and the Veterans Affairs Medical Center in Fresno, California, presented findings of a subgroup of patients in the Statins Therapies for Elevated Lipid Levels Compared Across dose to Rosuvastatin (STELLAR) trial. The subgroup consisted of 811 patients meeting the definition of metabolic syndrome, with a mean low-density lipoprotein (LDL) cholesterol level of 190 mg/dL and a mean triglyceride level of 215 mg/dL.

"At least one quarter of the U.S. population has the metabolic syndrome," Dr. Deedwania told meeting attendees, adding that the number is increasing steadily as the incidence of obesity increases. Because dyslipidemia is a hallmark of the syndrome, aggressive therapy to bring lipid levels to target is a focus of treatment.

For a six-week treatment period, patients were randomized to rosuvastatin 10 mg, 20 mg, or 40 mg; atorvastatin 10 mg, 20 mg, 40 mg, or 80 mg; simvastatin 10 mg, 20 mg, or 40 mg; or pravastatin 10 mg, 20 mg, or 40 mg.

"Rosuvastatin achieved the greatest decrease in LDL cholesterol at the highest dose," Dr. Deedwania said. The 40-mg dose reduced LDL cholesterol levels 55% compared with a 50% reduction with the highest dose of atorvastatin, a 47% reduction with 40 mg simvastatin, and a 29% reduction with 40 mg pravastatin.

Triglyceride levels were reduced 34% with 40 mg rosuvastatin, 33% with 80 mg atorvastatin, 23% with 40 mg simvastatin, and 15% with 40 mg pravastatin.

HDL cholesterol levels were increased more than 10% with rosuvastatin 40 mg, nearly 5% with atorvastatin 80 mg, 10% with 40 mg simvastatin, and 6.4% with 40 mg pravastatin.

Although this study was made up of patients with metabolic syndrome, Dr. Deedwania told Medscape that rosuvastatin's effects are similar in other patients with hypercholesterolemia and that it has a safety profile similar to that of other statins. He added that he would now choose rosuvastatin over other statins.

Thomas A. Pearson, MD, PhD, from the University of Rochester School of Medicine and Dentistry in New York, said that although the STELLAR findings are strong, he is not yet ready to give up prescribing other available statins.

"Rosuvastatin is known to be more potent than the other statins, but it is a new drug on the market. As far as we know it has the same side effects of all the other statins on the market, but we're all waiting for the long-term data on rosuvastatin before we start using it widely," Dr. Pearson said.

"I use all the statins and see benefits with them all. What we want to do is get LDL cholesterol to target and we'll use whatever we can, including adding a drug like ezetimibe that acts to lower cholesterol through another mechanism," Dr. Pearson said.

The STELLAR study was sponsored by AstraZeneca, the maker of rosuvastatin.

ACC 53rd Annual Scientific Session: Abstract 820-1. Presented March 8, 2004.

Reviewed by Gary D. Vogin, MD



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