Kinetics of inhibition of HMG-CoA reductase by a new statin, rosuvastatin
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Objective: No clinical trials have been conducted to directly compare the effect of the two high-intensity statins, rosuvastatin and atorvastatin, on cardiovascular outcomes. However, three such trials have been computer-simulated using the Archimedes model, an individual-based simulation of human physiology and behaviors, treatment interventions, and health care systems. The results are reviewed here. Methods: The first simulated trial assessed clinical outcomes in patients receiving available doses of the two drugs. The second assessed the impact of initial treatment decisions, while the third assessed the effect of switching from rosuvastatin to atorvastatin. Results: In the first simulated trial, treatment with rosuvastatin was estimated to result in greater reductions than treatment with atorvastatin in major adverse cardiac event (MACE) rates at 5 years and 20 years at all doses examined (relative risk [RR]: 0.897, 0.888, and 0.930 at 5 years for rosuvastatin 20 mg vs atorvastatin 40 mg, rosuvastatin 40 mg vs atorvastatin 80 mg, and rosuvastatin 20 mg vs atorvastatin 80 mg, respectively; all P <0.05). In the second simulated trial, outcomes were significantly better in patients initially prescribed rosuvastatin than in those initially prescribed atorvastatin (RR of MACE at 5 years: 0.918; P <0.001). In the third simulated trial, risk of MACE was significantly greater in patients switching from rosuvastatin to atorvastatin than in those remaining on rosuvastatin (RR at 5 years: 1.109; P <0.001). Conclusion: The results of these simulated clinical trials suggest improved outcomes among patients receiving rosuvastatin relative to patients receiving atorvastatin in various clinical settings. Keywords: statins, rosuvastatin, atorvastatin, simulated clinical trials, outcome assessment
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Rosuvastatin Calcium
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Background: Statins are very effective in controlling hyperlipidemia, the leading cause of cardiovascular diseases. The most common, worldwide side effect of statins is myopathy. The study aims to compare safety and efficacy of most commonly used statins i.e. atorvastatin and rosuvastatin and effectiveness of CoQ10 in managing statin induced myopathy. Materials and Methods: An investigational study design was adopted using randomized trials at Punjab Institute of Cardiology, Lahore Pakistan from November 2016 - February 2017. A total of 95 male and female patients were enrolled between the age ranges of 40-80 years, using atorvastatin and rosuvastatin. Lipid profile, total cholesterol, serum HDL-C, serum triglycerides, LDL-C and total cholesterol/HDL-C ratio were analysed from blood samples. The effectiveness of CoQ10 was found by the blood CPK levels. Results: The results showed that gender and dose had significant correlation with CPK levels, (p=0.001) and (p>0.001) respectively. Patients using rosuvastatin 20 mg were significantly on high risk to myopathy as compared to atorvastatin 40mg (p=0.023). 20 mg atorvastatin was more prone to induce statin induced myopathy compared to 10 mg (p=0.001). Atorvastatin 20 mg showed higher levels of CPK as compared to rosuvastatin 10 mg (p=0.002). Significant increases in the levels of CPK also found with rosuvastatin 20 mg and atorvastatin 20 mg (p>0.001). Rosuvastatin 20 mg significantly increases the risk of myopathy compared to atorvastatin 10 mg (p>0.001). The effect of rosuvastatin 20 mg was significantly poor than atorvastatin 10 mg (p=0.001). Atorvastatin 10 mg was more efficacious than rosuvastatin 20 mg (p=0.026). The levels of CPK significantly reduced after treatment with CoQ10 (P=0.022). Conclusions: It was concluded that rosuvastatin users were more prone to the risk of myopathy, myalgic symptoms and rise in CPK levels were dose related, and both statins were equally effective. It was further concluded that CoQ10 was quite effective in lowering the levels of CPK and for the reversal of myalgiaa.
Hyperlipidemia
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Dyslipidemia is the multiple lipid metabolic disorders which is one of the high risk factors for the atherosclerotic diseases. It increases the morbidity and mortality and therefore, must be treated with antilipidemic agents. HMG-Co A reductase inhibitors (statins), one of many antidyslipidemic agents, have shown to be significant improvement from the various cholesterol levels. Especially, data from many comparative trials suggest that rosuvastatin is more effective than atorvastatin among many other statins. The aims of this study were to evaluate the efficacy and safety between rosuvastatin and atorvastatin in the treatment of Korean patients with dyslipidemia. Currently the Korean Society of Lipidology and Atherosclerosis based on the Korean health screening data suggests that Korean patients with dyslipidemia should be treated by the target cholesterol levels according to the Adult Treatment Panel III guidelines of the US National Cholesterol Education Program (NCEP-ATP III). We reviewed retrospectively all medical histories of the total 392 dyslipidemic patients with atorvastatin or rosuvastatin from June 1st, 2004 to August 31st, 2006 in Chungbuk National University Medical Center. Patients were classified as total 4 groups by the NCEP-ATP III Guidelines. The numbers of enrolled patients were each 5 mg atorvastatin (n=34), 10 mg atorvastatin (n=148), 5 mg rosuvastatin (n=94) and 10 mg rosuvastatin (n=82). In comparison between groups, rosuvastatin groups in the lowering LDL-C had better efficacies, and the results were each 22% (5 mg atorvastatin), 33.3% (10 mg atorvastatin), 35% (5 mg rosuvastatin) and 41.3% (10 mg rosuvastatin) with the dose relationship (P=0.000). Rosuvastatin groups also have shown to be more significantly reducing Total Cholesterol levels compared to atorvastatin groups with the no dose relationship (P=0.000). In the lowering of non-HDL cholesteroles, rosuvastatin groups showed significantly better efficacies than atorvastatin with the dose-relationship (P=0.000). Each medication groups did not demonstrate the differences in the changing of HDL cholesterol and triglyceride levels (P=0.096, 0.309, respectively). In conclusion, rosuvastatin was better efficacious than atrovastatin in reducing LDL-C Total Chol, and Tg. Therefore, rosuvastatin is a good antilipidemic agents for Korean patients with dyslipidemia and it can use to minimize the morbidity and mortality related to the cardiovascular diseases in Korean.
Dyslipidemia
Rosuvastatin Calcium
Pharmacotherapy
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Aim: The aim of this analysis was to compare the effectiveness of rosuvastatin in lowering cholesterol with that of atorvastatin in patients at high risk of dyslipidaemia. Place and Duration: In the Medicine department of Islam Medical College and Teaching Hospital Sialkot for six months duration from June 2021 to November 2021. Methods: This randomized, open-label study enrolled 90 patients with high-risk dyslipidaemia and diagnosed according to the international guidelines for the prevention of adult dyslipidaemia. These patients were randomized to rosuvastatin and atorvastatin to receive rosuvastatin 20 mg / day and atorvastatin 20 mg / day, respectively, for three months. In both groups, the efficacy of atorvastatin and rosuvastatin on the concentration of LDL-C, HDL-C, total cholesterol (TC) and triglycerides (TG) was assessed. In addition, the rates of achieving LDL-C or TC target levels were assessed in both groups. Results: Rosuvastatin caused a significantly greater reduction of LDL-C (43.2% and 38.1%, p <0.05) and TC (34.8% Vs 28.1%, p <0.05) than Atorvastatin. In addition, the percentage of subjects attaining the recommended target TC and LDL-C levels was higher in the group of rosuvastatin as compared to the atorvastatin group. Conclusions: In patients at high risk of hyperlipidemia, rosuvastatin has high efficacy in decreasing lipids than atorvastatin. Keywords: rosuvastatin, atorvastatin, dyslipidaemia, high-density lipoprotein, triglycerides.
Hyperlipidemia
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Objective:To investigate the effects of different dose of atorvastatin and rosuvastatin treatment comprehensive clinical effect in patients with acute coronary syndrome.Methods:According to the different treatment 135 cases of acute coronary syndrome patients were grouped,rosuvastatin group 45cases(10mg rosuvastatin),atorvastatin group A 45cases(10mg atorvastatin)and atorvastatin group B 45cases(20mg atorvastatin),the changes of blood lipid the inflammatory factor and compared before and after treatment in three groups.Results:Rosuvastatin,atorvastatin group B in patients with PAI-1,MMP-9,TC,LDL-C decreased significantly better than atorvastatin group A,P0.05;rosuvastatin no significant correlation between the changes of serum levels of inflammatory factors in the atorvastatin group and blood lipid level.Conclusion:The use of rosuvastatin and atorvastatin treatment ACS can effectively make inflammation factors level in serum decreased,and the decreased effect of drug related with measurement.
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Previous studies have shown that the commonly used statin lipid lowering drugs can delay the progression of atherosclerotic plaque. Atorvastatin can stabilize atherosclerotic plaque, but it can not reverse atheromatous plaque. This study will compare the efficacy of rosuvastatin and atorvastatin in the treatment of atherosclerosis and try to prove that the use of statins can improve peripheral atherosclerosis and reverse atherosclerotic plaque. The results showed that 10 mg rosuvastatin was more effective than 20 mg atorvastatin in lowering serum lipid level and elevating ABI index, ABI as rosuvastatin group (0.782±0.236) and atorvastatin group(0.541±0.196). After 6 months of treatment, the carotid artery IMT in rosuvastatin group and atorvastatin group decreased compared with before treatment, and the difference was statistically significant (P<0.05). The TC/mmol⋅L-1 is 2.83±0.56 in rosuvastatin group and 3.24±0.71 in atorvastatin group. In addition, rosuvastatin did not increase the risk of adverse reactions compared with atorvastatin. The results confirm that statin therapy can improve peripheral atherosclerosis and reverse atherosclerotic plaques.
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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.
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The Dutch campaign 'Verstandig kiezen', based on the American programme 'Choosing wisely', aims to improve quality in healthcare, with attention to cost control. The 'Choosing wisely'-based programme can be applied in the choice of a statin. Atorvastatin and rosuvastatin are regarded as equal choices in various guidelines regarding cardiovascular risk management. Generic atorvastatin is available, and is approximately 25 times cheaper than rosuvastatin in almost equipotent doses. Rosuvastatin provides a greater LDL reduction than atorvastatin. Patient LDL targets can usually be achieved with atorvastatin, and rosuvastatin is not needed. At group level, there are no relevant differences in adverse-events profile between both statins. Atorvastatin and rosuvastatin do have different pharmacokinetic interactions. When changing medication, good provision of information is a prerequisite for patient satisfaction and compliance. We advise use of atorvastatin instead of rosuvastatin as drug of choice when the LDL target is not reached using simvastatin. However, under specific conditions, rosuvastatin should be the treatment of choice. Efficacy and adverse effects should then be evaluated at individual patient level.
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