Lipid-lowering Eeficacy and Safety of High Doses of Atorvastatin and Rosuvastatin

Abstract

Administration of high doses of atorvastatin 80 mg/day and rosuvastatin 40 mg/day is a part of a standard algorithm for the treatment of patients at high and very high cardiovascular risk. This treatment allows reducing atherogenic low-density lipoprotein cholesterol (LDL-C) by approximately 50 % and decreasing the risk of cardiovascular diseases. Results of prospective studies with atorvastatin and rosuvastatin demonstrated a significant (45–55 %) decrease in LDL-C and triglycerides (11–50 %). This article focuses on analysis of evidence-based retrospective database for atorvastatin and rosuvastatin in prospective studies; reviewing a retrospective database of the VOYAGER study, including subgroups of patents with type 2 diabetes mellitus or hypertriglyceridemia; evaluation of the variability of the hypolipidemic response; and analysis of the risk for development of cardiovascular diseases and their complications with the statin treatment. Rosuvastatin at the highest daily dose of 40 mg/day was superior to atorvastatin 80 mg/day by the capability for decreasing LDL-C. Both statins showed a great variability in the degree of reducing triglycerides and exerted a minimal effect on high-density lipoprotein cholesterol. According to results of completed studies, rosuvastatin 40 mg/day also was superior to high doses of atorvastatin by tolerability and safety.

Modern algorithms for statin therapy

“…Мнимая непереносимость статинов в клинической практике статинов нередко является серьезным барьером в адекватной терапии. Реальная частота отмены статинов по данным исследования USAGE была 7,5% [44], а встречаемость фармакологических (не общих) случаев статинассоциированной миопатии составляет лишь 1-2% (0,5-4%) [45], а вовсе не 10,5%, как сообщалось в высокоцитируемом исследовании PRIMO 2005г [46]. Другой тезис, который активно продвигается в практическом здравоохранении как основание для старта комбинированной гиполипидемической терапии: статины в высоких дозах недостаточно снижают уровень ХС-ЛНП.…”