Comparison of the efficacy of rosuvastatin versus atorvastatin, simvastatin, and pravastatin in achieving lipid goals: results from the STELLAR trial

Abstract

In the Statin Therapies for Elevated Lipid Levels compared Across doses to Rosuvastatin (STELLAR) trial, the efficacy of rosuvastatin calcium (Crestor) was compared with that of atorvastatin (Lipitor), simvastatin (Zocor), and pravastatin (Pravachol) for lowering plasma low-density lipoprotein cholesterol (LDL-C) after 6 weeks of treatment. In this multicenter, parallel-group, open-label trial, adults with hypercholesterolemia were randomized to treatments with rosuvastatin 10, 20, 40, or 80 mg, atorvastatin 10, 20, 40, or 80 mg, simvastatin 10, 20, 40, or 80 mg, or pravastatin 10, 20, or 40 mg. Efficacy and safety results from this trial have been previously published. The additional analyses included in this report show that 53% (83/156) to 80% (125/157) of patients in the rosuvastatin 10- to 40-mg groups achieved LDL-C levels < 100 mg/dl (< 2.6 mmol/l), compared with 18% (28/158) to 70% (115/165) of patients who received atorvastatin, 8% (13/165) to 53% (86/163) of patients who received simvastatin, and 1% (1/160) to 8% (13/161) of patients who received pravastatin. Other additional analyses showed that more patients in the rosuvastatin 10- to 40-mg groups than in the comparator groups who were at high risk of coronary heart disease according to National Cholesterol Education Program Adult Treatment Panel (ATP) III, Joint European Societies, or Canadian guidelines achieved the LDL-C goals of < 100 mg/dl (< 2.6 mmol/l) (55% to 77% compared with 0 to 64%), < 3.0 mmol/l (< 116 mg/dl) (76% to 94% compared with 6% to 81%), and < 2.5 mmol/l (< 97 mg/dl) (47% to 69% compared with 0 to 53%), respectively. Results favoring rosuvastatin versus the comparators were also reported for patients: (a) who had triglycerides > or = 200mg/dl (> or = 2.3 mmol/l), and achieved both ATP III LDL-C and non-high-density lipoprotein cholesterol (non-HDL-C) goals (80% to 84% versus 15% to 84%); (b) overall who achieved the Canadian LDL-C goals of < 2.5 (< 97 mg/dl) to < 5.0 mmol/l (< 193 mg/dl) (85% to 91% versus 44% to 86%); and (c) who achieved all 3 Canadian goals for LDL-C, triglycerides (< 3.0 mmol/l [< 266 mg/dl] to < 2.0 mmol/l [< 177 mg/dl]), and the total cholesterol/high-density lipoproteincholesterol ratio (< 4 to < 7) (70% to 83% versus 35% to 79%).

Drug-Drug Interactions between Rosuvastatin and Oral Antidiabetic Drugs Occurring at the Level of OATP1B1

“…Rosuvastatin belongs to the class of statin drugs, which are widely prescribed and act by inhibiting hydroxymethylglutaryl-CoA reductase, resulting in reduced plasma concentrations of low-density lipoprotein cholesterol (McKenney et al, 2003). After oral dosage, the rather hydrophilic rosuvastatin is efficiently and rapidly taken up from the portal vein into hepatocytes, which is predominantly mediated by the uptake transporter OATP1B1 (Ho et al, 2006;Kitamura et al, 2008;Choi et al, 2011).…”

Effectiveness of statins for secondary prevention in elderly patients after acute myocardial infarction: an evaluation of class effect

“…A number of RCTs have directly compared statins using surrogate end points, such as lipid reduction, [21][22][23] markers of hemostasis and inflammation [24][25][26] or reduction in number of atherotic plaques. 27 However, the extent to which these results can be extrapolated to clinically relevant outcomes remains to be established.…”

Role of Powerful Statins in Modern Treatment of Patients With a High Risk of Complications Arising From Atherosclerosis

“…Для этого следует иметь информацию об относительном влиянии примене-ния разных доз различных статинов на уровень ХС ЛПНП в крови, а также о частоте достижения целевых концен-траций ХС ЛПНП при использовании таких доз. Ответы на эти вопросы были получены в ходе выполнения много-центрового рандомизированного открытого исследова-ния STELLAR (Statin Therapies for Elevated Lipid Levels compared Across doses to Rosuvastatin) [14,15]. В исследо-вание были включены 2 268 больных с гиперхолестери-немией, которых распределяли в группы приема розува-статина по 10, 20, 40 и ли 80 мг/сут, аторвастатина по 10, 20, 40 или 80 мг/сут, симвастатина по 10, 20, 40 или 80 мг/сут, а также правастатина по 10, 20 или 40 мг/сут в течение 6 нед.…”