BMJ
High-intensity statins: How do they stack up in CAD?
Among adults with coronary artery disease (CAD), rosuvastatin and atorvastatin demonstrated comparable efficacy for the composite of all-cause mortality, MI, stroke, or any coronary revascularization at three years. Rosuvastatin was associated with lower LDL-C levels but a higher risk of new-onset DM requiring antidiabetic therapy and cataract surgery, compared with atorvastatin.
- In the randomized, open label, multicenter LODESTAR trial, 4,400 adults (age ≥19 years) with CAD were assigned to receive either rosuvastatin (n=2,204) or atorvastatin (n=2,196). Primary outcome was a three-year composite of all cause death, MI, stroke, or any coronary revascularization. Secondary outcomes were safety endpoints: new-onset DM; hospital admissions due to heart failure; DVT or PE; endovascular revascularization for PAD; aortic intervention or surgery; end stage kidney disease; discontinuation of study drugs due to intolerance; cataract surgery; and a composite of lab-detected abnormalities.
- 4,341 participants (98.7%) completed the trial. Mean daily dose of study drugs was 17.1 mg in the rosuvastatin group and 36.0 mg in the atorvastatin group at three years. The rate of the primary outcome was 8.7% in the rosuvastatin group and 8.2% in the atorvastatin group (hazard ratio [HR], 1.06, 95% confidence interval [CI], 0.86-1.30; P=0.58). Mean LDL-C level during treatment was 69.6 mg/dL in the rosuvastatin group and 73.5 mg/dL in the atorvastatin group (P<0.001).
- Rosuvastatin recipients had a higher incidence of new onset DM requiring initiation of antidiabetics (7.2% vs. 5.3%; HR, 1.39, 95% CI, 1.03-1.87; P=0.03) and cataract surgery (2.5% vs. 1.5%; HR, 1.66, 95% CI, 1.07-2.58; P=0.02). Other safety endpoints were similar between groups.
Source:
Lee Y-J, et al. (2023, October 15). BMJ.Rosuvastatin versus atorvastatin treatment in adults with coronary artery disease: secondary analysis of the randomised LODESTAR trial. https://pubmed.ncbi.nlm.nih.gov/37852649/