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27.11.2018 | Original articles

Efficacy and safety of rosuvastatin vs. atorvastatin in lowering LDL cholesterol

A meta-analysis of trials with East Asian populations

verfasst von: L. Zhang, S. Zhang, Y. Yu, Prof. H. Jiang, Prof. J. Ge

Erschienen in: Herz | Ausgabe 6/2020

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Abstract

Background

The VOYAGER meta-analysis reported on the low-density lipoprotein cholesterol (LDL-C)-lowering effect of commonly used statins in Caucasian subjects. As there is limited literature available on the efficacy of statins in Asian populations, the current meta-analysis compared the effects of rosuvastatin and atorvastatin on LDL-C levels in an East Asian population.

Methods

The MEDLINE, PubMed, Embase, Cochrane Library, and Web of Science databases were searched for randomized controlled trials comparing lipid-lowering effects of rosuvastatin and atorvastatin in an East Asian population. Data on the study design, participant characteristics, and outcomes were extracted. Odds ratios (OR), weighted mean differences (WMD), or standardized mean differences were calculated using the random-effects model.

Results

The meta-analysis comprised 16 randomized controlled trials with 5930 participants. Compared with atorvastatin, patients treated with rosuvastatin had a significant reduction in LDL-C: WMD = −7.15 mg/dl (95% confidence intervals [CI]: −10.71–−3.60) mg/dl, p < 0.0001. Meta-regression analyses revealed no significant association between the superior benefits of rosuvastatin and other variables including age, sex, baseline LDL-C level, and follow-up duration. Additionally, the rosuvastatin group of patients, who were treated with half the dose of atorvastatin, achieved a significantly greater reduction in LDL-C levels (WMD = −3.57; 95% CI: −5.40–−1.74 mg/dl, p < 0.001). Both rosuvastatin and atorvastatin were well tolerated, with similar incidences of adverse events.

Conclusion

Similar to the VOYAGER meta-analysis, which reported a greater efficacy of rosuvastatin in comparison with atorvastatin and simvastatin in Caucasian patients, we found that the efficacy of rosuvastatin was superior to atorvastatin in East Asian patients with hypercholesterolemia.

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Cholesterol Treatment Trialists’ (CTT) Collaboration (2010) Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from 170 000 participants in 26 randomised trials. Lancet 376:1670–1681. https://doi.org/10.1016/S0140-6736(10)61350-5CrossRef

Cholesterol Treatment Trialists’ (CTT) Collaborators (2012) The effects of lowering LDL cholesterol with statin therapy in people at low risk of vascular disease: meta-analysis of individual data from 27 randomised trials. Lancet 380:581–590. https://doi.org/10.1016/S0140-6736(12)60367-5CrossRef

Stone NJ, Robinson JG, Lichtenstein AH et al (2014) 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 63:2889–2934. https://doi.org/10.1016/j.jacc.2013.11.002CrossRefPubMed

Reiner Ž, Catapano AL, De Backer G et al (2011) ESC/EAS Guidelines for the management of dyslipidaemiasThe Task Force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS). Eur Heart J 32:1769–1818. https://doi.org/10.1093/eurheartj/ehr158CrossRefPubMed

Anderson TJ, Grégoire J, Hegele RA et al (2013) 2012 update of the Canadian Cardiovascular Society guidelines for the diagnosis and treatment of dyslipidemia for the prevention of cardiovascular disease in the adult. Can J Cardiol 29:151–167. https://doi.org/10.1016/j.cjca.2012.11.032CrossRefPubMed

(2010) Managing your dyslipidemia with TLC: Therapeutic Lifestyle Changes. JAOA, p eS17

Jellinger PS (2018) American Association of Clinical Endocrinologists/American College of Endocrinology Management of Dyslipidemia and Prevention of Cardiovascular Disease Clinical Practice Guidelines. Diabetes Spectr 31:234–245. https://doi.org/10.2337/ds18-0009CrossRefPubMedPubMedCentral

Mahmood D, Jahan K, Habibullah K (2015) Primary prevention with statins in cardiovascular diseases: A Saudi Arabian perspective. J Saudi Heart Assoc 27:179–191. https://doi.org/10.1016/j.jsha.2014.09.004CrossRefPubMed

Schooling CM, Au Yeung SL, Leung GM (2014) Why do statins reduce cardiovascular disease more than other lipid modulating therapies? Eur J Clin Invest 44:1135–1140. https://doi.org/10.1111/eci.12342CrossRefPubMed

10.

Jones PH, Davidson MH, Stein EA et al (2003) Comparison of the efficacy and safety of rosuvastatin versus atorvastatin, simvastatin, and pravastatin across doses (STELLAR* Trial). Am J Cardiol 92:152–160CrossRef

11.

Nicholls SJ, Brandrup-Wognsen G, Palmer M, Barter PJ (2010) Meta-analysis of comparative efficacy of increasing dose of Atorvastatin versus Rosuvastatin versus Simvastatin on lowering levels of atherogenic lipids (from VOYAGER). Am J Cardiol 105:69–76. https://doi.org/10.1016/j.amjcard.2009.08.651CrossRefPubMed

12.

Barter PJ, Brandrup-Wognsen G, Palmer MK, Nicholls SJ (2010) Effect of statins on HDL-C: a complex process unrelated to changes in LDL-C: analysis of the VOYAGER Database. J Lipid Res 51:1546–1553. https://doi.org/10.1194/jlr.P002816CrossRefPubMedPubMedCentral

13.

Gijsberts CM, den Ruijter HM, Asselbergs FW et al (2015) Biomarkers of Coronary Artery Disease Differ Between Asians and Caucasians in the General Population. Glob Heart 10(1):301–311.e1. https://doi.org/10.1016/j.gheart.2014.11.004CrossRefPubMed

14.

Moher D, Liberati A, Tetzlaff J et al (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Plos Med 6:e1000097. https://doi.org/10.1371/journal.pmed.1000097CrossRefPubMedPubMedCentral

15.

Geng Q, Ren J, Song J et al (2014) Meta-analysis of the effect of statins on renal function. Am J Cardiol 114:562–570. https://doi.org/10.1016/j.amjcard.2014.05.033CrossRefPubMed

16.

Tsutamoto T, Sakai H, Ibe K et al (2011) Effect of atorvastatin vs. rosuvastatin on cardiac sympathetic nerve activity in non-diabetic patients with dilated cardiomyopathy. Circ J 75:2160–2166CrossRef

17.

Saku K, Zhang B, Noda K, PATROL Trial Investigators (2011) Randomized head-to-head comparison of pitavastatin, atorvastatin, and rosuvastatin for safety and efficacy (quantity and quality of LDL): the PATROL trial. Circ J 75:1493–1505CrossRef

18.

Teramoto T, Sawada T, Iwamoto K, Daida H (2012) Clinical efficacy and tolerability of ezetimibe in combination with atorvastatin in Japanese patients with hypercholesterolemia-ezetimibe phase IV randomized controlled trial in patients with hypercholesterolemia. Curr Ther Res Clin Exp 73:16–40. https://doi.org/10.1016/j.curtheres.2012.02.002CrossRefPubMedPubMedCentral

19.

Yamazaki T, Kurabayashi M, ASTRO-1 Study Group (2009) A randomized controlled study to compare the effects of rosuvastatin 5 mg and atorvastatin 10 mg on the plasma lipid profile in Japanese patients with hypercholesterolemia (ASTRO-2). Ann Vasc Dis 2:159–173. https://doi.org/10.3400/avd.AVDoa090019CrossRefPubMed

20.

Mori Y, Kuriyama G, Tanaka T, Tajima N (2009) Usefulness of aggressive lipid-lowering therapy with rosuvastatin in hypercholesterolemic patients with concomitant type 2 diabetes. Endocrine 36:412–418. https://doi.org/10.1007/s12020-009-9235-6CrossRefPubMed

21.

Kurabayashi M, Yamazaki T, SUBARU Study Group (2008) Superior benefit of aggressive lipid-lowering therapy for high-risk patients using statins: the SUBARU study—more hypercholesterolemic patients achieve Japan Atherosclerosis Society LDL-C goals with rosuvastatin therapy than with atorvastatin therapy. J Atheroscler Thromb 15:314–323CrossRef

22.

Ogawa H, Matsui K, Saito Y et al (2014) Differences between rosuvastatin and atorvastatin in lipid-lowering action and effect on glucose metabolism in Japanese hypercholesterolemic patients with concurrent diabetes. Lipid-lowering with highly potent statins in hyperlipidemia with type 2 diabetes patients (LISTEN) study. Circ J 78:2512–2515CrossRef

23.

Qu H‑Y, Xiao Y‑W, Jiang G‑H et al (2009) Effect of atorvastatin versus rosuvastatin on levels of serum lipids, inflammatory markers and adiponectin in patients with hypercholesterolemia. Pharm Res 26:958–964. https://doi.org/10.1007/s11095-008-9798-6CrossRefPubMed

24.

Park J‑S, Kim Y‑J, Choi J‑Y et al (2010) Comparative study of low doses of rosuvastatin and atorvastatin on lipid and glycemic control in patients with metabolic syndrome and hypercholesterolemia. Korean J Intern Med 25:27–35. https://doi.org/10.3904/kjim.2010.25.1.27CrossRefPubMedPubMedCentral

25.

Lee CW, Kang S‑J, Ahn J‑M et al (2012) Comparison of effects of atorvastatin (20 mg) versus rosuvastatin (10 mg) therapy on mild coronary atherosclerotic plaques (from the ARTMAP trial). Am J Cardiol 109:1700–1704. https://doi.org/10.1016/j.amjcard.2012.01.399CrossRefPubMed

26.

Yun KH, Park H‑Y, Choi J‑H et al (2007) Comparison of efficacy and safety after administering high potency statin to high risk patients: rosuvastatin 10 mg versus atorvastatin 20 mg. Korean Circ J 37:154. https://doi.org/10.4070/kcj.2007.37.4.154CrossRef

27.

Zhu J, Tomlinson B, Ro YM et al (2007) A randomised study comparing the efficacy and safety of rosuvastatin with atorvastatin for achieving lipid goals in clinical practice in Asian patients at high risk of cardiovascular disease (DISCOVERY-Asia study). Curr Med Res Opin 23:3055–3068CrossRef

28.

Shioji K, Izuhara M, Mitsuoka H et al (2014) Achievement rates of Japan Atherosclerosis Society Guidelines 2007 LDL-cholesterol goals with rosuvastatin or atorvastatin in patients who had not achieved their goal with atorvastatin. Cardiovasc Ther 32:97–104. https://doi.org/10.1111/1755-5922.12066CrossRefPubMed

29.

Her A‑Y, Kim J‑Y, Kang S‑M et al (2010) Effects of atorvastatin 20 mg, rosuvastatin 10 mg, and atorvastatin/ezetimibe 5 mg/5 mg on lipoproteins and glucose metabolism. J Cardiovasc Pharmacol Ther 15:167–174. https://doi.org/10.1177/1074248409357922CrossRefPubMed

30.

Hong YJ, Jeong MH, Hachinohe D et al (2011) Comparison of effects of rosuvastatin and atorvastatin on plaque regression in Korean patients with untreated intermediate coronary stenosis. Circ J 75:398–406CrossRef

31.

Bando Y, Toyama H, Kanehara H et al (2016) Switching from atorvastatin to rosuvastatin lowers small, dense low-density lipoprotein cholesterol levels in Japanese hypercholesterolemic patients with type 2 diabetes mellitus. Diabetes Res Clin Pract 111:66–73. https://doi.org/10.1016/j.diabres.2015.10.013CrossRefPubMed

32.

Navarese EP, Buffon A, Andreotti F et al (2013) Meta-analysis of impact of different types and doses of Statins on new-onset diabetes mellitus. Am J Cardiol 111:1123–1130. https://doi.org/10.1016/j.amjcard.2012.12.037CrossRefPubMed

33.

Liao JK, Laufs U (2005) Pleiotropic effects of statins. Annu Rev Pharmacol Toxicol 45:89–118. https://doi.org/10.1146/annurev.pharmtox.45.120403.095748CrossRefPubMedPubMedCentral

34.

Karlson BW, Palmer MK, Nicholls SJ et al (2015) To what extent do high-intensity statins reduce low-density lipoprotein cholesterol in each of the four statin benefit groups identified by the 2013 American College of Cardiology/American Heart Association guidelines? A VOYAGER meta-analysis. Atherosclerosis 241:450–454. https://doi.org/10.1016/j.atherosclerosis.2015.05.029CrossRefPubMed

35.

Roberts WC (2004) Two more drugs for dyslipidemia. Am J Cardiol 93:809–811. https://doi.org/10.1016/j.amjcard.2004.01.022CrossRefPubMed

36.

Istvan ES, Deisenhofer J (2001) Structural mechanism for statin inhibition of HMG-CoA reductase. Science 292:1160–1164. https://doi.org/10.1126/science.1059344CrossRefPubMed

37.

McTaggart F (2003) Comparative pharmacology of rosuvastatin. Atheroscler Suppl 4:9–14CrossRef

Titel: Efficacy and safety of rosuvastatin vs. atorvastatin in lowering LDL cholesterol
A meta-analysis of trials with East Asian populations
verfasst von: L. Zhang
S. Zhang
Y. Yu
Prof. H. Jiang
Prof. J. Ge
Publikationsdatum: 27.11.2018
Verlag: Springer Medizin
Erschienen in: Herz / Ausgabe 6/2020
Print ISSN: 0340-9937
Elektronische ISSN: 1615-6692
DOI: https://doi.org/10.1007/s00059-018-4767-2

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