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Comparative Drug Evaluation of Atorvastatin versus Rosuvastatin in Pharmacotherapy of Korean Patients with Dyslipidemia

  • Published : 2008.03.28

Abstract

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.

Keywords

References

  1. Strutt et al, 2004 Guidelines for Hyperlipidemia Therapy, 2006
  2. Blasetto, J. W., E. A. Stein, W. V. Brown, R. Chitra, and A. Raza (2003), 'Efficacy of rosuvastatin compared with other statins at selected starting doses in hypercholesterolemic patients and in special population groups,' Am J Cardiol, 91(5A), 3C-10C; discussion10C https://doi.org/10.1016/S0002-9149(03)00567-8
  3. Brown, M. S., and J. L. Goldstein(1986), 'A receptor-mediated pathway for cholesterol homeostasis,' Science, 232(4746), 34-47 https://doi.org/10.1126/science.3513311
  4. Carrilho, A. J., W. L. Medina, E. R. Nakandakare, and E. C. Quintao(1997), 'Plasma cholesteryl ester transfer protein is lowered by treatment of hypercholesterolemia with cholestyramine,' Clin Pharmacol Ther, 62(1), 82-88 https://doi.org/10.1016/S0009-9236(97)90154-5
  5. Davidson, M., P. Ma, E. A. Stein, A. M. Gotto, Jr., A. Raza, R. Chitra, and H. Hutchinson(2002), 'Comparison of effects on low-density lipoprotein cholesterol and highdensity lipoprotein cholesterol with rosuvastatin versus atorvastatin in patients with type IIa or IIb hypercholesterolemia,' Am J Cardiol, 89 (3), 268-275 https://doi.org/10.1016/S0002-9149(01)02226-3
  6. De Backer, G., E. Ambrosioni, K. Borch-Johnsen, C. Brotons, R. Cifkova, J. Dallongeville, S. Ebrahim, O. Faergeman, I. Graham, G. Mancia, V. Manger Cats, K. Orth- Gomer, J. Perk, K. Pyorala, J. L. Rodicio, S. Sans, V. Sansoy, U. Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (2001), 'Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III),' Jama, 285(19), 2486-2497 https://doi.org/10.1001/jama.285.19.2486
  7. Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (2001), "Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III)," Jama, 285(19), 2486-2497 https://doi.org/10.1001/jama.285.19.2486
  8. Sechtem, S. Silber, T. Thomsen, and D. Wood(2003), "European guidelines on cardiovascular disease prevention in clinical practice. Third Joint Task Force of European and Other Societies on Cardiovascular Disease Prevention in Clinical Practice," Eur Heart J, 24(17), 1601-1610
  9. Endo, A., Y. Tsujita, M. Kuroda, and K. Tanzawa(1977), 'Inhibition of cholesterol synthesis in vitro and in vivo by ML-236A and ML-236B, competitive inhibitors of 3- hydroxy-3-methylglutaryl-coenzyme A reductase,' Eur J Biochem, 77(1), 31-36 https://doi.org/10.1111/j.1432-1033.1977.tb11637.x
  10. Gagne, C. H. E. Bays, S. R. Weiss, P. Mata, K. Quinto, M. Melino, M. Cho, T. A. Musliner, and B. Gumbiner(2002), 'Efficacy and safety of ezetimibe added to ongoing statin therapy for treatment of patients with primary hypercholesterolemia,' Am J Cardiol, 90(10), 1084-1091 https://doi.org/10.1016/S0002-9149(02)02774-1
  11. Heart Protection Study Collaborative Group (2002), 'MRC/ BHF Heart Protection Study of cholesterol lowering with simvastatin in 20,536 high-risk individuals: a randomised placebo-controlled trial,' Lancet, 360(9326), 7-22 https://doi.org/10.1016/S0140-6736(02)09327-3
  12. Japan Atherosclerosis Society (2002), 'Japan Atherosclerosis Society (JAS) guidelines for diagnosis and treatment of atherosclerotic cardiovascular disease.' Tokyo JAS
  13. Jones, P., S. Kafonek, I. Laurora, and D. Hunninghake( 1998), 'Comparative dose efficacy study of atorvastatin versus simvastatin, pravastatin, lovastatin, and fluvastatinin patients with hypercholesterolemia(the CURVES study),' Am J Cardiol, 81 (5), 582-587 https://doi.org/10.1016/S0002-9149(97)00965-X
  14. Long-Term Intervention with Pravastatin in Ischaemic Disease (LIPID) Study Group.(1998) 'Prevention of cardiovascular events and death with pravastatin in patients with coronary heart disease and a broad range of initial cholesterol levels.' N Engl J Med, 339, 1349-1357 https://doi.org/10.1056/NEJM199811053391902
  15. Lloret, R., J. Ycas, M. Stein, and S. Haffner(2006), 'Comparison of rosuvastatin versus atorvastatin in Hispanic- Americans with hypercholesterolemia(from the STARSHIP trial),' Am J Cardiol, 98(6), 768-773 https://doi.org/10.1016/j.amjcard.2006.04.014
  16. Mabuchi, H., T. Kita, M. Matsuzaki, Y. Matsuzawa, N. Nakaya, S. Oikawa, Y. Saito, J. Sasaki, K. Shimamoto, and H. Itakura (2002), 'Large scale cohort study of the relationship between serum cholesterol concentration and coronary events with low-dose simvastatin therapy in Japanese patients with hypercholesterolemia and coronary heart disease: secondary prevention cohort study of the Japan Lipid Intervention Trial (J-LIT),' Circ J, 66(12), 1096-1100 https://doi.org/10.1253/circj.66.1096
  17. Maron, D. J., S. Fazio, and M. F. Linton(2000), 'Current perspectives on statins,' Circulation, 101(2), 207-213 https://doi.org/10.1161/01.CIR.101.2.207
  18. Menotti, A., A. Keys, H. Blackburn, D. Kromhout, M. Karvonen, A. Nissinen, J. Pekkanen, S. Punsar, F. Fidanza, S. Giampaoli, F. Seccareccia, R. Buzina, I. Mohacek, S. Nedeljkovic, C. Aravanis, A. Dontas, H. Toshima, and M. Lanti(1996), 'Comparison of multivariate predictive power of major risk factors for coronary heart diseases in different countries: results from eight nations of the Seven Countries Study, 25-year follow-up,' J Cardiovasc Risk, 3(1), 69-75 https://doi.org/10.1097/00043798-199602000-00010
  19. Olsson, A. G., H. Istad, O. Luurila, L. Ose, S. Stender, J. Tuomilehto, O. Wiklund, H. Southworth, J. Pears, and J. W. Wilpshaar(2002), 'Effects of rosuvastatin and atorvastatin compared over 52 weeks of treatment in patients with hypercholesterolemia,' Am Heart J, 144(6), 1044-1051 https://doi.org/10.1067/mhj.2002.128049
  20. Sacks, F. M., L. A. Moye, B. R. Davis, T. G. Cole, J. L. Rouleau, D. T. Nash, M. A. Pfeffer, and E. Braunwald(1998), 'Relationship between plasma LDL concentrations during treatment with pravastatin and recurrent coronary events in the Cholesterol and Recurrent Events trial,' Circulation, 97(15), 1446-1452 https://doi.org/10.1161/01.CIR.97.15.1446
  21. Scandinavian Simvastatin Survival Study Group (1994), 'Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S),' Lancet, 344(8934), 1383-1389
  22. Shepherd, J., S. M. Cobbe, I. Ford, C. G. Isles, A. R. Lorimer, P. W. MacFarlane, J. H. McKillop, and C. J. Packard(1995), 'Prevention of coronary heart disease with pravastatin in men with hypercholesterolemia. West of Scotland Coronary Prevention Study Group,' N Engl J Med, 333(20), 1301-1307 https://doi.org/10.1056/NEJM199511163332001
  23. Stamler, J., D. Wentworth, and J. D. Neaton(1986), 'Is relationship between serum cholesterol and risk of premature death from coronary heart disease continuous and graded? Findings in 356,222 primary screenees of the Multiple Risk Factor Intervention Trial (MRFIT),' Jama, 256(20), 2823-2828 https://doi.org/10.1001/jama.1986.03380200061022
  24. Stein E, Strutt KL, Miller E, Southworth H. (2001) 'Rosuvastatin (20, 40 and 80 mg) reduces LDL-C, raises HDL-C and achieves treatment goals more effectively than atorvastatin (20, 40 and 80 mg) in patients with heterozygous familial hypercholesterolemia' Atherosclerosis (2) 90
  25. Strutt, K. R. Caplan, H. Hutchison, A. Dane, and J. Blasetto (2004), 'More Western hypercholesterolemic patients achieve Japan Atherosclerosis Society LDL-C goals with rosuvastatin therapy than with atorvastatin, pravastatin, or simvastatin therapy,' Circ J, 68(2), 107- 113 https://doi.org/10.1253/circj.68.107
  26. Sytkowski, P. A., R. B. D'Agostino, A. Belanger, and W. B. Kannel(1996), 'Sex and time trends in cardiovascular disease incidence and mortality: the Framingham Heart Study, 1950-1989,' Am J Epidemiol, 143(4), 338-350 https://doi.org/10.1093/oxfordjournals.aje.a008748
  27. Ulahannan, T. J.(1998), 'Amiodarone prophylaxis for atrial fibrillation after cardiac surgery,' N Engl J Med, 338(19), 1384

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