Benefits of Rosuvastatin in Cardiovascular Protection Remain Unclear After HOPE-3

Abstract

he use of commercialized statins in the prevention of cardiovascular diseases (CVD) has commonly been accepted based on the informative results of the Cholesterol Treatment Trialists (CTT) reports [1] As an additional effort in the prevention of CVD, professional societies have issued practical recommendations for healthcare providers on the effective use of statins in lowering low-density-lipoprotein cholesterol (LDL-C) [2]. Among these statins, atorvastatin and rosuvastatin are regarded as the most effective as they can reduce more than 30% of LDL-C, even at low doses (i.e. atorvastatin 10 mg; rosuvastatin 5 mg) [2]. The results of the recent HOPE-3 study [3], in which 10 mg rosuvastatin was found to reduce the development of CVD by 24% in intermediate-risk persons, may reinforce the role of rosuvastatin in CVD prevention. However, there are some concerns regarding the use of rosuvastatin.Based on the CTT report [1] and our recent literature review [4], 6 atorvastatin and 4 rosuvastatin studies, characterized by their rigorous double-blind, randomized, placebo-controlled study designs, have been published in the past two decades. A meta-analysis using a random effect model showed that atorvastatin significantly reduced the risk of CVD, with an odds ratio (OR) of 0.82 (95% CI: 0.75-0.90, p <0.001, Figure 1). In contrast, the results of a meta-analysis including the 4 rosuvastatin trials failed to detect a significant reduction in CVD risk, with an OR of 0.86 (0.69-1.07, p = 0.163). Surprisingly, the effect of rosuvastatin in CVD risk prevention remained controversial, even after inclusion of the encouraging HOPE-3 study [3] in the analysis, which then yielded an overall OR of 0.84 (0.70-1

Monomeric CRP regulates inflammatory responses in human intervertebral disc cells

“…hs-CRP), describing values below 10 μg/ml. According to several studies [41][42][43][44][45][46][47] and to the guidance of the USA Food and Drug Administration (FDA), 48 the clinical significance of such values is questionable.…”