Preview

Rational Pharmacotherapy in Cardiology

Advanced search

Short Term Comparison Between Safety and Efficacy of Rosuvastatin 40 mg and Atorvastatin 80 mg in Patients with Acute Coronary Syndrome

https://doi.org/10.20996/1819-6446-2018-14-5-636-645

Full Text:

Abstract

Background. Dyslipidemia is one of the most serious modifiable risk factors for acute coronary  syndrome which is the most leading cause of mortality and morbidity worldwide.

Aim. To assess the short-term safety and efficacy of full dose rosuvastatin and atorvastatin in patients with acute coronary  syndrome.

Material and methods. Single center, prospective, randomized study included 100 patients who were randomized from first 24-hour of admission to either atorvastatin 80  mg  daily (group 1) or rosuvastatin 40  mg  daily (group 2). Primary outcomes included levels of inflammatory markers (erythrocyte sedimentation rate [ESR], high-sensitive C-reactive protein [hs-CRP] and total leukocyte count [TLC]) after 4 weeks of treatment and lipid profile after 3 months. Secondary  outcomes included recurrent myocardial infarction, recurrent angina, stroke and side effects.

Results. At admission, both groups  were comparable in age, without statistically significant difference regarding risk factors (diabetes, hypertension, smoking and obesity), echocardiography (end-diastolic volume, end-systolic volume and ejection fraction), laboratory parameters of inflammation and lipid profile. After 1 month, there was insignificant difference between rosuvastatin and atorvastatin in the reduction of ESR, Hs-CRP or TLC. After 3 months rosuvastatin showed statistically significant reduction in the level of low-density lipoprotein cholesterol, triglyceride (p<0.001) and significant increase in high-density lipoprotein cholesterol (p<0.001) when compared to atorvastatin and at the same time the rosuvastatin group  was safer regarding liver enzymes elevation, p<0.001 for alanine and p<0.01 for aspartate aminotransferases, respectively.

Conclusions. Our findings demonstrated that  rosuvastatin 40  mg/day is safer and more effective than  the atorvastatin 80  mg/day in the terms  of lipid parameters and inflammatory biomarkers.

About the Authors

Sh. A. Mostafa
Benha University, Faculty of Medicine, Cardiovascular Department
Egypt

Shaimaa Ahmed Mostafa – Assistant Professor of Cardiology, Department of Cardiology.

Fareed Nada Street, Benha, Qalubiya Governorate, 13511.



Kh. Elrabat
Benha University, Faculty of Medicine, Cardiovascular Department
Egypt

Khalid Elrabat – Department of Cardiology.

Fareed Nada Street, Benha, Qalubiya Governorate, 13511.



M. Mahrous
Benha University, Faculty of Medicine, Cardiovascular Department
Egypt

Mohamed Mahrous – Department of Cardiology.

Fareed Nada Street, Benha, Qalubiya Governorate, 13511.



M. Kamal
Benha University, Faculty of Medicine, Cardiovascular Department
Egypt

Marwa Kamal – Department of Cardiology.

Fareed Nada Street, Benha, Qalubiya Governorate, 13511.



References

1. Schuetz C.A., van Herick A., Alperin P., et al. Comparing the effectiveness of rosuvastatin and atorvastatin in preventing cardiovascular outcomes: estimates using the Archimedes model. J Med Econ. 2012;15:1118-29. doi:10.3111/13696998.2012.704459.

2. Moustapha A., Anderson H.V. Contemporary view of the acute coronary syndromes. J Invasive Cardiol. 2003;15:71-9.

3. Granger C.B., Weaver W.D. Reducing cardiac events after acute coronary syndromes. Rev Cardiovasc Med. 2004;5 Suppl 5:S39-46.

4. Angeli F., Reboldi G., Mazzotta G., et al. Statins in acute coronary syndrome: Very early initiation and benefits. Ther Adv Cardiovasc Dis. 2012;6:163-74. doi:10.1177/1753944712452463.

5. Grundy S.M., Cleeman J.I., Merz C.N.B., et al. Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III guidelines. Circulation. 2004;110:227-39. doi:10.1161/01.CIR.0000133317.49796.0E.

6. Verschuren W.M., Jacobs D.R., Bloemberg B.P., et al. Serum total cholesterol and long-term coronary heart disease mortality in different cultures. Twenty-five-year follow-up of the seven countries study. JAMA. 1995;274:131-6.

7. Chen Z., Peto R., Collins R., et al. Serum cholesterol concentration and coronary heart disease in population with low cholesterol concentrations. BMJ. 1991;303:276-82.

8. Yusuf S., Hawken S., Ounpuu S., et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet (London, England). 2004;364:937-52. doi:10.1016/S0140-6736(04)17018-9.

9. O’Keefe J.H., Cordain L., Harris W.H., et al. Optimal low-density lipoprotein is 50 to 70 mg/dl: lower is better and physiologically normal. J Am Coll Cardiol. 2004;43:2142-6. doi:10.1016/j.jacc.2004.03.046.

10. Heart Protection Study Collaborative Group. MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20,536 high-risk individuals: a randomised placebo-controlled trial. Lancet (London, England). 2002;360:7-22. doi:10.1016/S0140-6736(02)09327-3.

11. Studer M., Briel M., Leimenstoll B., et al. Effect of different antilipidemic agents and diets on mortality: a systematic review. Arch Intern Med. 2005;165:725-30. doi:10.1001/archinte.165.7.725.

12. Briggs M.R., Yokoyama C., Wang X., et al. Nuclear protein that binds sterol regulatory element of low density lipoprotein receptor promoter. I. Identification of the protein and delineation of its target nucleotide sequence. J Biol Chem. 1993;268:14490-6.

13. Liao J.K. Effects of statins on 3-hydroxy-3-methylglutaryl coenzyme a reductase inhibition beyond low-density lipoprotein cholesterol. Am J Cardiol. 2005;96:24F-33F. doi:10.1016/j.amjcard.2005.06.009.

14. Fukumoto Y., Libby P., Rabkin E., et al. Statins alter smooth muscle cell accumulation and collagen content in established atheroma of watanabe heritable hyperlipidemic rabbits. Circulation. 2001;103:993-9.

15. Link A., Selejan S., Hewera L., et al. Rosuvastatin induces apoptosis in CD4+CD28null T cells in patients with acute coronary syndromes. Clin Res Cardiol. 2011;100:147-58. doi:10.1007/s00392-010-0225-8.

16. Chou R., Dana T., Blazina I., et al. Statins for Prevention of Cardiovascular Disease in Adults: Systematic Review for the U.S. Preventive Services Task Force. AHRQ Publ. 2016:178.

17. Cannon C.P., Steinberg B.A., Murphy S.A., et al. Meta-Analysis of Cardiovascular Outcomes Trials Comparing Intensive Versus Moderate Statin Therapy. J Am Coll Cardiol. 2006;48:438-45. doi:10.1016/j.jacc.2006.04.070.

18. Cannon C.P., Braunwald E., McCabe C.H., et al. Intensive versus Moderate Lipid Lowering with Statins after Acute Coronary Syndromes. N Engl J Med. 2004;350:1495-504. doi:10.1056NEJ-Moa040583.

19. Thompson P.L., Meredith I., Amerena J., et al. Effect of pravastatin compared with placebo initiated within 24 hours of onset of acute myocardial infarction or unstable angina: The Pravastatin in Acute Coronary Treatment (PACT) trial. Am Heart J. 2004;148:91. doi:10.1016/j.ahj.2003.10.052.

20. Liem A.H., van Boven A.J., Veeger N.J.G.M., et al. Effect of fluvastatin on ischaemia following acute myocardial infarction: a randomized trial. Eur Heart J. 2002;23:1931-7.

21. Khurana S., Gupta S., Bhalla H., et al. Comparison of anti-inflammatory effect of atorvastatin with rosuvastatin in patients of acute coronary syndrome. J Pharmacol Pharmacother. 2015;6:130-5. doi:10.4103/0976-500X.162011.

22. Aydin M.U., Aygul N., Altunkeser B.B., et al. Comparative effects of high-dose atorvastatin versus moderate-dose rosuvastatin on lipid parameters, oxidized-LDL and inflammatory markers in ST elevation myocardial infarction. Atherosclerosis. 2015;239:439-43. doi:10.1016/j.atherosclerosis.2015.02.003.

23. Balk E.M., Lau J., Goudas L.C., et al. Effects of statins on nonlipid serum markers associated with cardiovascular disease: a systematic review. Ann Intern Med. 2003;139:670-82.

24. Pitt B., Loscalzo J., Monyak J., et al. Comparison of Lipid-Modifying Efficacy of Rosuvastatin Versus Atorvastatin in Patients with Acute Coronary Syndrome (from the LUNAR Study). Am J Cardiol. 2012;109:1239-46. doi:10.1016/j.amjcard.2011.12.015.

25. Everett B.M., Glynn R.J., MacFadyen J.G., Ridker P.M. Rosuvastatin in the Prevention of Stroke Among Men and Women With Elevated Levels of C-Reactive Protein: Justification for the Use of Statins in Prevention: An Intervention Trial Evaluating Rosuvastatin (JUPITER). Circulation. 2010;121:143-50. doi:10.1161/CIRCULATIONAHA.109.874834


For citation:


Mostafa S.A., Elrabat K., Mahrous M., Kamal M. Short Term Comparison Between Safety and Efficacy of Rosuvastatin 40 mg and Atorvastatin 80 mg in Patients with Acute Coronary Syndrome. Rational Pharmacotherapy in Cardiology. 2018;14(5):636-645. (In Russ.) https://doi.org/10.20996/1819-6446-2018-14-5-636-645

Views: 219


Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.


ISSN 1819-6446 (Print)
ISSN 2225-3653 (Online)