Efficacy and Tolerability of Rosuvastatin and Atorvastatin when Force-Titrated in Patients with Primary Hypercholesterolemia

Abstract

Background: Patients at high risk of cardiovascular disease frequently fail to reach recommended low-density lipoprotein cholesterol (LDL-C) goals, partly because statin doses are not titrated to optimal effect. The ECLIPSE study was designed to compare the efficacy and safety of force-titrated treatment with rosuvastatin (10–40 mg) with that of atorvastatin (10–80 mg) in high-risk patients with hypercholesterolemia. Methods: In this 24-week, open-label, randomized, multinational, parallel-group study, 1,036 patients were randomized to rosuvastatin (n = 522) or atorvastatin (n = 514). Results: At all time points, a significantly greater percentage of patients on rosuvastatin treatment achieved the NCEP ATP III LDL-C goal of <100 mg/dl (2.5 mmol/l), the 2003 European LDL-C target of <2.5 or 3.0 mmol/l (100 or 115 mg/dl) and the LDL-C goal of <70 mg/dl (1.8 mmol/l), a goal suggested for very high-risk patients (p < 0.001 for all). Rosuvastatin also achieved significantly greater improvements in components of the atherogenic lipid profile versus atorvastatin. Both treatments were well tolerated. Conclusion: Rosuvastatin titrated across its recommended dose range provides a more favorable effect on lipoprotein variables than atorvastatin, enabling more high-risk patients to achieve recommended LDL-C goals.

The apoB/apoA-I Ratio is a Strong Predictor of Cardiovascular Risk

“…The mode of actions of statins and their effects on lipids and apos is reviewed in more detail elsewhere (163)(164)(165). The most commonly used drugs today are the statins that can reduce apoB synthesis and increase apoA-I synthesis and turnover.…”

“…The most effective apoB-reducing statins are atorvastatin and rosuvastatin which lower the apoB-values by about 40-45% and 45-50%, respectively. Best increase in apoA-I concentrations is obtained by rosuvastatin which can increase the value by about 10-15% depending on baseline values, the lower the higher is the increase (163)(164)(165). Commonly for all statins there is a strong dose-response relationship, except for atorvastatin where higher doses commonly result in lowering of HDL-C and apoA-I values.…”

“…A vast number of studies, both in primary and secondary prevention, have shown that there is a close relationship between LDL-C and CV event rates, the lower the LDL-C, the lower is the risk (163)(164)(165). In several of these trials also apoB, apoA-I and the apo-ratio have been measured.…”

Ask Your Doctor? Direct-to-Consumer Advertising of Pharmaceuticals

“…7 They use the results of this trial in marketing. See, for example, http://www.crestor.com/c/about-crestor/crestorclinical-studies.aspx, andFaergeman et al (2008) for the clinical trial results.8 Congress specifically sent a letter to the FDA to challenge marketing of Vytorin(Mathews (2008)). 9 The study was completed in 2006.…”

Altering Serum Lipids to Reduce Progression of Chronic Kidney Disease

“…Despite these differences, the authors concluded that rosuvastatin and atorvastatin were similarly well tolerated [61]. The study showed that increasing doses of rosuvastatin produced a dose-related increase in the incidence of proteinuria (from 0.2 to 1.8%) and hematuria (from 2.9 to 4.0%), whereas this effect was not apparent with atorvastatin.…”